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General NPI Number Information
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NPI Number | 1932557360
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Entity Type | Individual
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Provider Name | TINA BEAR RN, CDE
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Gender | Female
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 300 2ND AVE NE
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City | JAMESTOWN
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State | ND
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Zip | 58401-3373
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Country | US
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Telephone | 701-952-4628
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Fax | 701-952-4611
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Provider Business Mailing Address
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Address Line | 300 2ND AVE NE
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City | JAMESTOWN
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State | ND
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Zip | 58401-3373
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Country | US
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Telephone | 701-952-4628
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Fax | 701-952-4611
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | R31370
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License Number State | ND
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