Healthcare Provider Details

I. General information

NPI: 1366254435
Provider Name (Legal Business Name): GRACE AND GRATITUDE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 09/02/2025
Certification Date: 02/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HIGHWAY 2 W STE 8
DEVILS LAKE ND
58301-2913
US

IV. Provider business mailing address

210 HIGHWAY 2 BOX 2
DEVILS LAKE ND
58301
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2039
  • Fax: 701-662-2049
Mailing address:
  • Phone: 701-739-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA JEAN LARSON
Title or Position: OWNER/DNP
Credential: DNP, FNP-C
Phone: 701-739-4228