Provider Demographics
NPI:1053143123
Name:ANDERSON, JARED WAYNE
Entity type:Individual
Prefix:MR
First Name:JARED
Middle Name:WAYNE
Last Name:ANDERSON
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 1:808 6TH ST APT F6
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-6430
Mailing Address - Country:US
Mailing Address - Phone:701-370-0254
Mailing Address - Fax:
Practice Address - Street 1:808 6TH ST APT F6
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-6430
Practice Address - Country:US
Practice Address - Phone:701-370-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No104100000XBehavioral Health & Social Service ProvidersSocial Worker