Provider Demographics
NPI:1952454829
Name:ENGELHART, JOLENE (NP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:ENGELHART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:FLEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:215 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:RICHARDTON
Mailing Address - State:ND
Mailing Address - Zip Code:58652-7109
Mailing Address - Country:US
Mailing Address - Phone:701-974-3372
Mailing Address - Fax:701-974-3220
Practice Address - Street 1:215 3RD AVE W
Practice Address - Street 2:
Practice Address - City:RICHARDTON
Practice Address - State:ND
Practice Address - Zip Code:58652-7109
Practice Address - Country:US
Practice Address - Phone:701-974-3372
Practice Address - Fax:701-974-3220
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23250363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19826Medicaid
NDP00767212OtherRR MEDICARE
NDP00767212OtherRR MEDICARE
NDN711645Medicare ID - Type Unspecified