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General NPI Number Information
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NPI Number | 1205814787
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Entity Type | Individual
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Provider Name | JACINTA-JON KLINDWORTH M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 1312 HWY 49 NW
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City | BEULAH
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State | ND
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Zip | 58523
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Country | US
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Telephone | 701-873-4445
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Fax | 701-873-4199
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Provider Business Mailing Address
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Address Line | 1710 62ND AVE SW
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City | BEULAH
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State | ND
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Zip | 58523-9152
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ND8665
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License Number State | ND
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