Healthcare Provider Details

I. General information

NPI: 1306495072
Provider Name (Legal Business Name): AMY GUZMAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

IV. Provider business mailing address

2500 FAIRWAY ST
DICKINSON ND
58601-2639
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR40606
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: