Healthcare Provider Details

I. General information

NPI: 1811134976
Provider Name (Legal Business Name): JESSICA M MEIER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BURDICK EXPY W
MINOT ND
58701-4406
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-5124
  • Fax: 701-857-5564
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR29334
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: