Healthcare Provider Details

I. General information

NPI: 1649355157
Provider Name (Legal Business Name): DAKOTA OSTEOPOROSIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E MAIN AVE
BISMARCK ND
58501-4525
US

IV. Provider business mailing address

705 E MAIN AVE
BISMARCK ND
58501-4525
US

V. Phone/Fax

Practice location:
  • Phone: 701-258-9418
  • Fax: 701-258-9423
Mailing address:
  • Phone: 701-258-9418
  • Fax: 701-258-9423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR25050
License Number StateND

VIII. Authorized Official

Name: MS. KRISTIE LEE TODD
Title or Position: FNP OWNER
Credential: FNP
Phone: 701-258-9418