Provider Demographics
NPI:1104421569
Name:HENRIKSON, JASAMIN
Entity type:Individual
Prefix:
First Name:JASAMIN
Middle Name:
Last Name:HENRIKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-6122
Mailing Address - Country:US
Mailing Address - Phone:701-351-7248
Mailing Address - Fax:
Practice Address - Street 1:922 6TH AVE
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-6122
Practice Address - Country:US
Practice Address - Phone:701-351-7248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant