Provider Demographics
NPI:1104927839
Name:TOMAN, JEAN (NP)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:TOMAN
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:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-0997
Mailing Address - Country:US
Mailing Address - Phone:701-667-4600
Mailing Address - Fax:701-530-3780
Practice Address - Street 1:2500 SUNSET DRIVE NW
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58554
Practice Address - Country:US
Practice Address - Phone:701-667-4600
Practice Address - Fax:701-530-3780
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR24734363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00339299OtherRR MEDICARE
ND19583Medicaid
ND19583Medicaid
NDP00339299OtherRR MEDICARE