Healthcare Provider Details

I. General information

NPI: 1962337659
Provider Name (Legal Business Name): NIKKI HALVORSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 5TH ST W STE 1
BOTTINEAU ND
58318-1204
US

IV. Provider business mailing address

314 5TH ST W STE 1
BOTTINEAU ND
58318-1204
US

V. Phone/Fax

Practice location:
  • Phone: 701-228-3613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number6135
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: