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NPI Code Detail

MEDICARE: JANELL KJOS FNP, BC

MEDICARE: JANELL KJOS FNP, BC
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
1363LF0000XFamily Nurse PractitionerR28369ND
2363L00000XNurse PractitionerR155546-0MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063414084
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANELL KJOS FNP, BC
Provider Business Mailing Address
First Line : 1027 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3409
Country : US
Telephone Number : 218-847-5611
Fax Number : 218-847-0881
Provider Business Practice Location Address
First Line : 1027 WASHINGTON AVE
Second Line :
City : DETROIT LAKES
State : MN
Zip : 56501-3409
Country : US
Telephone Number : 218-847-5611
Fax Number : 218-847-0881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 09/13/2012

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