Healthcare Provider Details

I. General information

NPI: 1619905528
Provider Name (Legal Business Name): UNIVERSITY OF NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E. ROSSER AVE.
BISMARCK ND
58501-4461
US

IV. Provider business mailing address

701 E. ROSSER AVE.
BISMARCK ND
58501-4461
US

V. Phone/Fax

Practice location:
  • Phone: 701-328-9950
  • Fax: 701-328-9957
Mailing address:
  • Phone: 701-751-9500
  • Fax: 701-751-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI MYRVIK
Title or Position: BUSINESS MANAGER
Credential:
Phone: 701-751-6753