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General NPI Number Information
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NPI Number | 1417181546
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Entity Type | Individual
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Provider Name | JULIE OVERBOE JARVIS DO
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Gender | Female
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Dates
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Enumeration Date | 05/04/2009
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Last Update Date | 07/01/2019
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Provider Practice Location Address
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Address Line | 100 4TH ST S
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City | FARGO
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State | ND
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Zip | 58103-1929
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Country | US
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Telephone | 701-234-3100
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Fax | 701-234-3120
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Provider Business Mailing Address
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Address Line | 1900 CENTRA CARE CIRCLE #2475 CENTRA CARE HEALTH PLAZA
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City | ST. CLOUD
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State | MN
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Zip | 56303-5000
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Country | US
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Telephone | 320-229-5199
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Fax | 320-229-5109
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 390200000X
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 53581
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 12325
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License Number State | ND
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