Healthcare Provider Details

I. General information

NPI: 1780514067
Provider Name (Legal Business Name): BRANDIN NYGAARD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 1ST AVE N STE 150
MOORHEAD MN
56560-0002
US

IV. Provider business mailing address

1530 11TH AVE S
FARGO ND
58103-3018
US

V. Phone/Fax

Practice location:
  • Phone: 218-228-3296
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: