Healthcare Provider Details

I. General information

NPI: 1003752262
Provider Name (Legal Business Name): ADVANCED CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

682 18TH AVE E STE A
DICKINSON ND
58601-6320
US

IV. Provider business mailing address

682 18TH AVE E STE A
DICKINSON ND
58601-6320
US

V. Phone/Fax

Practice location:
  • Phone: 701-590-2549
  • Fax:
Mailing address:
  • Phone: 701-590-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL JEAN SULLIVAN
Title or Position: OWNER/NURSE PRACTITIONER
Credential: FNP-C
Phone: 701-590-2549