=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730905258
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORDYN LEA IRENE GEFFRE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2024
-----------------------------------------------------
Last Update Date | 11/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2101 ELM ST N
-----------------------------------------------------
City | FARGO
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58102-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-232-3241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18080 96TH ST SE
-----------------------------------------------------
City | FAIRMOUNT
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58030-9537
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-305-0915
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R50892
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------