Healthcare Provider Details

I. General information

NPI: 1952817132
Provider Name (Legal Business Name): KRISTY M WEIGUM DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2017
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501
US

IV. Provider business mailing address

PO BOX 997
BISMARCK ND
58502-0997
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR35928
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: