Active NPI
Jerilyn Ann Klein Wangen, PHARMD
- Pharmacist
- Fargo, ND
National Provider Identifier
1972852747
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5390
- Practice address
- 712 38TH St NW Ste a
Fargo, ND 58102-2955 - Phone
- (701) 893-9217
- Fax
- (701) 893-9223
- NPI assigned
- Sep 7, 2012
- Last updated
- Sep 7, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5390 | ND | Primary |
Addresses
Primary practice location
712 38TH St NW Ste a
Fargo, ND 58102-2955
Mailing address
712 38TH St NW Ste a
Fargo, ND 58102-2955
Phone (701) 893-9217
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
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5390 | ND | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346976000000",
"number": "1972852747",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "712 38TH ST NW STE A",
"city": "FARGO",
"state": "ND",
"postal_code": "581022955",
"telephone_number": "701-893-9217",
"fax_number": "701-893-9223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 38TH ST NW STE A",
"city": "FARGO",
"state": "ND",
"postal_code": "581022955",
"telephone_number": "701-893-9217",
"fax_number": "701-893-9223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLEIN WANGEN",
"first_name": "JERILYN",
"middle_name": "ANN",
"name_prefix": "Mrs.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-07",
"last_updated": "2012-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ND",
"license": "5390",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.