Healthcare Provider Details

I. General information

NPI: 1891650040
Provider Name (Legal Business Name): JUDITH ANN DANIELS CNA, NHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4822 N 19TH ST
BISMARCK ND
58503-5687
US

IV. Provider business mailing address

4822 N 19TH ST
BISMARCK ND
58503-5687
US

V. Phone/Fax

Practice location:
  • Phone: 701-351-3887
  • Fax:
Mailing address:
  • Phone: 701-351-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number33614
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: