Healthcare Provider Details

I. General information

NPI: 1619503760
Provider Name (Legal Business Name): NURTURING WELLNESS PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 INTERCHANGE AVE STE 200
BISMARCK ND
58501-2084
US

IV. Provider business mailing address

5119 FOUNTAINBLUE DR
BISMARCK ND
58503-8893
US

V. Phone/Fax

Practice location:
  • Phone: 401-952-0293
  • Fax:
Mailing address:
  • Phone: 401-952-0293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KATHY MELISSA ANDERSON
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 401-952-0293