Provider Demographics
NPI:1932120276
Name:UNTERSEHER, JEANNE A (NP)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:A
Last Name:UNTERSEHER
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 1:730 MAIN ST E
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-1606
Mailing Address - Country:US
Mailing Address - Phone:701-786-4500
Mailing Address - Fax:701-786-4545
Practice Address - Street 1:730 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:ND
Practice Address - Zip Code:58257-1606
Practice Address - Country:US
Practice Address - Phone:701-786-4500
Practice Address - Fax:701-786-4545
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S66970Medicare UPIN