Individual provider Active NPI

Jeanette Lucille Rosenheim, RN

  • Ambulatory Care Registered Nurse
  • Fort Totten, ND
National Provider Identifier
1467575159
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Care Registered NurseTaxonomy code 163WP2201X
License
R21283 Issued in ND
Practice address
Spirit Lake Health Center
3883 74TH Ave NE Box 309
Fort Totten, ND 58335
Phone
(701) 776-1600
Fax
(701) 766-1626
NPI assigned
Apr 9, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Care Registered Nurse 163WP2201X R21283 ND Primary

Addresses

Primary practice location

Spirit Lake Health Center
3883 74TH Ave NE Box 309
Fort Totten, ND 58335

Mailing address

1127 5TH St NE
Devils Lake, ND 58301-2707
Phone (701) 662-8365

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R21283NDMDAmbulatory Care Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467575159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 5TH ST NE",
            "city": "DEVILS LAKE",
            "state": "ND",
            "postal_code": "583012707",
            "telephone_number": "701-662-8365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SPIRIT LAKE HEALTH CENTER",
            "address_2": "3883 74TH AVE NE BOX 309",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "58335",
            "telephone_number": "701-776-1600",
            "fax_number": "701-766-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENHEIM",
        "first_name": "JEANETTE",
        "middle_name": "LUCILLE",
        "name_prefix": "Ms.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP2201X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Ambulatory Care",
            "state": "ND",
            "license": "R21283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Totten, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.