=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558185074
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL ANN JAHNER RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2024
-----------------------------------------------------
Last Update Date | 11/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 ELM ST N
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58102-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-410-9723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7021 GOLDEN VALLEY PKWY S
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58104-7358
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Registered Nurse
-----------------------------------------------------
License Number | R24623
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------