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NPI Code Detail

MEDICARE: JESSICA TWEETON RN

MEDICARE: JESSICA TWEETON RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR44730ND

General Provider Information

NPI Number : 1043855539
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA TWEETON RN
Provider Business Mailing Address
First Line : PO BOX 480
Second Line :
City : FORT TOTTEN
State : ND
Zip : 58335-0480
Country : US
Telephone Number : 701-766-4236
Fax Number : 701-766-4878
Provider Business Practice Location Address
First Line : 816 3RD AVE N
Second Line :
City : FORT TOTTEN
State : ND
Zip : 58335-9998
Country : US
Telephone Number : 701-766-4236
Fax Number : 701-766-4878
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2019
Last Update Date : 11/08/2019

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