MEDICARE: MARIAH ULUAVE APRN, FNP-C

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	11125	MN
2	363LF0000X	Family Nurse Practitioner	R51271	ND

General Provider Information

NPI Number	:	1770354821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH ULUAVE APRN, FNP-C

Provider Business Mailing Address
First Line	:	5356 W PLUM DR
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-0620
Country	:	US
Telephone Number	:	208-201-0938
Fax Number	:

Provider Business Practice Location Address
First Line	:	5356 W PLUM DR
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58203-0620
Country	:	US
Telephone Number	:	208-201-0938
Fax Number	:

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

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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