Provider Demographics
NPI:1790539831
Name:DUBOIS, JENNNIFER LEE (CNA/CMALL)
Entity Type:Individual
Prefix:
First Name:JENNNIFER
Middle Name:LEE
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:CNA/CMALL
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 34
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329-0034
Mailing Address - Country:US
Mailing Address - Phone:701-244-2250
Mailing Address - Fax:
Practice Address - Street 1:3061 HIGHWAY 281 # U102
Practice Address - Street 2:
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329-7400
Practice Address - Country:US
Practice Address - Phone:701-472-1609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDDUB-82-3283253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care