Provider Demographics
NPI:1508083015
Name:KLEINKNECHT, JAMIE TODD (RN)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:TODD
Last Name:KLEINKNECHT
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 1:5013 WAGON WHEEL CIR
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-1050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5013 WAGON WHEEL CIR
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-1050
Practice Address - Country:US
Practice Address - Phone:701-663-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29443163WC0200X, 163WP2201X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Not Answered163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
Not Answered163WX0106XNursing Service ProvidersRegistered NurseOccupational Health