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General NPI Number Information
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NPI Number | 1235006933
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Entity Type | Individual
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Provider Name | ATEWA MIRABEL JINOR
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Gender |
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 1720 UNIVERSITY DR S
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City | FARGO
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State | ND
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Zip | 58103-4940
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Country | US
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Telephone | 701-280-4468
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Fax |
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Provider Business Mailing Address
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Address Line | 315 31ST AVE E UNIT 5
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City | WEST FARGO
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State | ND
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Zip | 58078-8378
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Country | US
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Telephone | 701-739-5144
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH6363
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 125620
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 21493-40
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License Number State | WI
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