Provider Demographics
NPI:1396268074
Name:SANDMAN, JENNA (NP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SANDMAN
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 1:3687 FAIRWAY RD N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1278
Mailing Address - Country:US
Mailing Address - Phone:701-290-0662
Mailing Address - Fax:
Practice Address - Street 1:1200 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2066
Practice Address - Country:US
Practice Address - Phone:701-663-5373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32611163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse