Healthcare Provider Details

I. General information

NPI: 1578405700
Provider Name (Legal Business Name): ADVANCED CARE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
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: 701-829-3396
  • Fax: 701-999-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL JEAN SULLIVAN
Title or Position: FAMILY NURSE PRACTITIONER
Credential: FNP-C
Phone: 701-829-3396