Healthcare Provider Details

I. General information

NPI: 1134129042
Provider Name (Legal Business Name): SHERI LOU KROGSTAD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 CENTRAL AVE NW
EAST GRAND FORKS MN
56721-1917
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 218-773-6800
  • Fax: 218-773-6861
Mailing address:
  • Phone: 701-780-1891
  • Fax: 701-780-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR27667
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2749
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: