Healthcare Provider Details

I. General information

NPI: 1801220058
Provider Name (Legal Business Name): JACQUELINE D SCHWAN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 2ND AVE W
WILLISTON ND
58801-5218
US

IV. Provider business mailing address

316 2ND AVE W
WILLISTON ND
58801-5218
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax: 701-774-4620
Mailing address:
  • Phone: 701-774-4600
  • Fax: 701-774-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR29182
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: