Individual
MS. JEANNE WAALEN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
4200 WOODHAVEN ST SW, FARGO, ND 58104-3946
(701) 364-3666
Mailing address
4200 WOODHAVEN ST SW, FARGO, ND 58104-3946
(701) 364-3666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC 0260
ND
Other
Enumeration date
06/08/2006
Last updated
07/08/2007
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