Healthcare Provider Details

I. General information

NPI: 1891062089
Provider Name (Legal Business Name): TRACI L CRAIGMILE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACI L DIETZ FNP-BC

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N 10TH ST
BISMARCK ND
58501-4516
US

IV. Provider business mailing address

310 N 10TH ST
BISMARCK ND
58501-4516
US

V. Phone/Fax

Practice location:
  • Phone: 701-877-2020
  • Fax: 701-639-2465
Mailing address:
  • Phone: 701-877-2020
  • Fax: 701-639-2465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR30427
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: