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NPI Code Detail

MEDICARE: JOLLEN MAE ESTUCHE JEREOS RN

MEDICARE: JOLLEN MAE ESTUCHE JEREOS 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 NurseR43942ND

General Provider Information

NPI Number : 1386420271
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLLEN MAE ESTUCHE JEREOS RN
Provider Business Mailing Address
First Line : 6506 27TH ST S
Second Line :
City : FARGO
State : ND
Zip : 58104-7968
Country : US
Telephone Number : 701-339-3206
Fax Number :
Provider Business Practice Location Address
First Line : 2101 ELM ST N
Second Line :
City : FARGO
State : ND
Zip : 58102-2417
Country : US
Telephone Number : 701-232-3241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2023
Last Update Date : 09/06/2023

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