Provider Demographics
NPI:1043107881
Name:MANSOUR, JEAN PAUL ELIA (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JEAN PAUL
Middle Name:ELIA
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2710
Mailing Address - Country:US
Mailing Address - Phone:701-799-4161
Mailing Address - Fax:
Practice Address - Street 1:1220 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2637
Practice Address - Country:US
Practice Address - Phone:701-234-4445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND202894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily