Healthcare Provider Details

I. General information

NPI: 1124972328
Provider Name (Legal Business Name): NICHOLE GUBBELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 18TH AVE S
FARGO ND
58103-4852
US

IV. Provider business mailing address

217 W ROSSER AVE
BISMARCK ND
58501-3755
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-8558
  • Fax: 701-255-3922
Mailing address:
  • Phone: 701-255-6909
  • Fax: 701-255-3922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5898
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2050
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: