Healthcare Provider Details

I. General information

NPI: 1952454829
Provider Name (Legal Business Name): JOLENE ENGELHART NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOLENE FLEMMER NP

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 3RD AVE W
RICHARDTON ND
58652-7109
US

IV. Provider business mailing address

215 3RD AVE W
RICHARDTON ND
58652-7109
US

V. Phone/Fax

Practice location:
  • Phone: 701-974-3372
  • Fax: 701-974-3220
Mailing address:
  • Phone: 701-974-3372
  • Fax: 701-974-3220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR23250
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: