Basic Information
| Provider Information | |||||||||
| NPI: | 1740667260 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEK | ||||||||
| FirstName: | JENEIL | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 32ND AVE S | ||||||||
| Address2: | ROUTE 2500 | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012348648 | ||||||||
| FaxNumber: | 7012348717 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 32ND AVE S | ||||||||
| Address2: | ROUTE 2500 | ||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012348648 | ||||||||
| FaxNumber: | 7012348717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 223412-0 | MN | N | Nursing Service Providers | Registered Nurse | Diabetes Educator | 163WD0400X | R33903 | ND | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.