Healthcare Provider Details

I. General information

NPI: 1962301507
Provider Name (Legal Business Name): KAITLIN WEISS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2026
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 SOO LINE DR
BISMARCK ND
58501-3339
US

IV. Provider business mailing address

128 SOO LINE DR
BISMARCK ND
58501-3339
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR41964
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: