Provider Demographics
NPI:1760370134
Name:FIORE, JONATHAN EDWARDS (LPN)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:EDWARDS
Last Name:FIORE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5963 HIGHWAY 85 APT 1206
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-9116
Mailing Address - Country:US
Mailing Address - Phone:808-783-0159
Mailing Address - Fax:
Practice Address - Street 1:1102 7TH AVE E
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4450
Practice Address - Country:US
Practice Address - Phone:701-770-3007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND201153164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse