Healthcare Provider Details

I. General information

NPI: 1316564115
Provider Name (Legal Business Name): ABBEY PELTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

IV. Provider business mailing address

9060 1ST ST SW
HALLIDAY ND
58636-9211
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-4445
  • Fax:
Mailing address:
  • Phone: 701-230-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR39027
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: