Provider Demographics
NPI:1073732939
Name:HJELSETH, JEFFREY WARREN (RN)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:WARREN
Last Name:HJELSETH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-1636
Mailing Address - Country:US
Mailing Address - Phone:701-740-4896
Mailing Address - Fax:
Practice Address - Street 1:17800 CAMP WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-4905
Practice Address - Country:US
Practice Address - Phone:801-878-5857
Practice Address - Fax:801-878-5560
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23536163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDR23536OtherNURSING CERTIFICATION NU