Healthcare Provider Details

I. General information

NPI: 1306669338
Provider Name (Legal Business Name): KIMBERLY C IVERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY C SILBERNAGEL RN

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE ST
BISMARCK ND
58503-0669
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-221-9152
  • Fax:
Mailing address:
  • Phone: 701-239-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR31703
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: