Healthcare Provider Details

I. General information

NPI: 1073917480
Provider Name (Legal Business Name): JESSICA M COMEAU FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA M HEGGEN FNP

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/18/2024
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3771
  • Fax: 701-842-4025
Mailing address:
  • Phone: 701-842-3771
  • Fax: 701-842-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33065
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: