Active NPI
Jauron Brandt Widow
- Nurse's Aide
- Eagle Butte, SD
National Provider Identifier
1932450822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse's Aide
- License
- A035180
- Practice address
- 24696 Airport Rd
Eagle Butte, SD 57625 - Phone
- (605) 964-7724
- NPI assigned
- Oct 2, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse's Aide | 376K00000X | A035180 | SD | Primary |
Addresses
Primary practice location
24696 Airport Rd
Eagle Butte, SD 57625
Mailing address
PO Box 1012
Eagle Butte, SD 57625
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A035180 | SD | MD | Nurse's Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349136000000",
"number": "1932450822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1012",
"city": "EAGLE BUTTE",
"state": "SD",
"postal_code": "57625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24696 AIRPORT RD",
"city": "EAGLE BUTTE",
"state": "SD",
"postal_code": "57625",
"telephone_number": "605-964-7724"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDOW",
"first_name": "JAURON",
"middle_name": "BRANDT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-02",
"last_updated": "2012-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "376K00000X",
"taxonomy_group": "",
"desc": "Nurse's Aide",
"state": "SD",
"license": "A035180",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagle Butte, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.