MEDICARE: REBECCA DOLEMAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	13504	MN
2	363LF0000X	Family Nurse Practitioner	AP124654	TX
3	363LF0000X	Family Nurse Practitioner	203100	ND

General Provider Information

NPI Number	:	1215366943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA DOLEMAN APRN

Provider Business Mailing Address
First Line	:	3800 56TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-6706
Country	:	US
Telephone Number	:	701-356-1500
Fax Number	:	701-356-1603

Provider Business Practice Location Address
First Line	:	3800 56TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-6706
Country	:	US
Telephone Number	:	701-356-1500
Fax Number	:	701-356-1603

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2013
Last Update Date	:	10/27/2025

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