Healthcare Provider Details

I. General information

NPI: 1790642544
Provider Name (Legal Business Name): ALISHA A CONCEPCION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 I94 BUSINESS LOOP E
DICKINSON ND
58601-6434
US

IV. Provider business mailing address

1463 I94 BUSINESS LOOP E
DICKINSON ND
58601-6434
US

V. Phone/Fax

Practice location:
  • Phone: 701-227-7500
  • Fax: 701-227-7575
Mailing address:
  • Phone: 701-227-7500
  • Fax: 701-227-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number813
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: