Provider Demographics
NPI:1669493888
Name:SELTVEDT, JEAN K (NP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:K
Last Name:SELTVEDT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-6050
Mailing Address - Country:US
Mailing Address - Phone:701-231-7331
Mailing Address - Fax:701-231-6132
Practice Address - Street 1:1707 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-6050
Practice Address - Country:US
Practice Address - Phone:701-231-7331
Practice Address - Fax:701-231-6132
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR17911363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN13067Medicare UPIN
R02182Medicare UPIN
ND500007325Medicare PIN