Healthcare Provider Details

I. General information

NPI: 1235826967
Provider Name (Legal Business Name): SYEDA SANA BISCHOFF FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 HIGHWAY 12 W
BOWMAN ND
58623-4507
US

IV. Provider business mailing address

1000 HIGHWAY 12
HETTINGER ND
58639-7530
US

V. Phone/Fax

Practice location:
  • Phone: 701-523-3271
  • Fax:
Mailing address:
  • Phone: 701-567-4561
  • Fax: 701-567-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR46153
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: