Healthcare Provider Details

I. General information

NPI: 1427660836
Provider Name (Legal Business Name): KIMBERLY SUE SVIDAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY SUE ALBERTSON RN

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 01/09/2024
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST NE
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

PO BOX 13780
GRAND FORKS ND
58208
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2157
  • Fax:
Mailing address:
  • Phone: 701-550-1988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR39352
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: