Healthcare Provider Details

I. General information

NPI: 1497275572
Provider Name (Legal Business Name): KRISTINE NICOLE GAYDA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 FAIRWAY ST
DICKINSON ND
58601
US

IV. Provider business mailing address

4128 111J AVE SW
DICKINSON ND
58601-8414
US

V. Phone/Fax

Practice location:
  • Phone: 701-456-6000
  • Fax:
Mailing address:
  • Phone: 701-290-5432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR35495
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR35495
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: