Provider Demographics
NPI:1215524137
Name:GAMES-CONWAY, JERICA
Entity type:Individual
Prefix:
First Name:JERICA
Middle Name:
Last Name:GAMES-CONWAY
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 1:7 LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ND
Mailing Address - Zip Code:58579-7200
Mailing Address - Country:US
Mailing Address - Phone:701-626-1401
Mailing Address - Fax:
Practice Address - Street 1:1020 N 12TH ST APT 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4387
Practice Address - Country:US
Practice Address - Phone:701-626-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1477969Medicaid