Provider Demographics
NPI:1760777031
Name:GRAHAM STEINHAUER, JESSICA (PMH-NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GRAHAM STEINHAUER
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2309
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-2309
Mailing Address - Country:US
Mailing Address - Phone:701-478-0333
Mailing Address - Fax:701-478-0434
Practice Address - Street 1:1316 23RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3707
Practice Address - Country:US
Practice Address - Phone:701-478-0333
Practice Address - Fax:701-478-0434
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33035163WP0808X, 363LP0808X
MNR 203852-0363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health