1407009400 NPI number — DR. JENNIFER M GARAAS PHD

Table of content: DR. JENNIFER M GARAAS PHD (NPI 1407009400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407009400 NPI number — DR. JENNIFER M GARAAS PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARAAS
Provider First Name:
JENNIFER
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407009400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 28TH ST. S.
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-356-1276
Provider Business Mailing Address Fax Number:
701-356-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 28TH ST. S.
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-356-4940
Provider Business Practice Location Address Fax Number:
701-356-4940
Provider Enumeration Date:
11/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  421 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1407009400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1407009400 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10007 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2677508 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1407009400 . This is a "BCBS ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 142P5GA . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1407009400 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".




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