Provider Demographics
NPI:1790670917
Name:WEBSTER, JONATHAN RAY
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:RAY
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 14 1/2 AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-5734
Mailing Address - Country:US
Mailing Address - Phone:701-720-2524
Mailing Address - Fax:
Practice Address - Street 1:1317 5TH ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5813
Practice Address - Country:US
Practice Address - Phone:701-720-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant