Basic Information
| Provider Information | |||||||||
| NPI: | 1588698088 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JONES-DEES | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES-DEES | ||||||||
| OtherFirstName: | JENIFER | ||||||||
| OtherMiddleName: | E | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 4450 31ST AVE S STE 102 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581044557 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012802033 | ||||||||
| FaxNumber: | 7012325578 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 9711 | ND | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1202940 | 01 | ND | MEDICA # | OTHER | 1202948 | 01 | ND | MEDICA # | OTHER | 34887 | 01 | ND | LHS # | OTHER | 13079 | 05 | ND | MEDICAID | 24550 | 01 | ND | NDBS # | OTHER | 751173600 | 05 | ND | MEDICAID | 833S4JO | 01 | ND | MNBS # | OTHER | HP42707 | 01 | ND | HEALTHPARTNERS # | OTHER | 137044 | 01 | ND | UCARE # | OTHER | 1202943 | 01 | ND | MEDICA # | OTHER | DA9011041662 | 01 | ND | PREFERRED ONE # | OTHER |