Healthcare Provider Details

I. General information

NPI: 1174184832
Provider Name (Legal Business Name): ANITA M FRU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2019
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 10TH ST
BISMARCK ND
58501-4516
US

IV. Provider business mailing address

1542 COLUMBIA DR
BISMARCK ND
58504-7147
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax:
Mailing address:
  • Phone: 763-227-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06192144
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: