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NPI Profile for JACOB K PEDERSON in FARGO, ND.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Gerontology |
363LG0600X | 50 | Nurse Practitioner |
| NPI # | 1770243727 |
|
| Status | Active | |
| Credentials | APRN CNP | |
| Entity | Individual | |
| Enumeration date | 12/17/2021 | |
| Last updated | 12/17/2021 - About 4 years ago | |
| Sole proprietor 1 | No | |
| Identifiers |
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| Hospital affiliation(s) |
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JACOB K PEDERSON
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JACOB K PEDERSON, APRN CNP