Healthcare Provider Details

I. General information

NPI: 1033926399
Provider Name (Legal Business Name): AMANDA BAIER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

3400 S BROADWAY
MINOT ND
58701-7420
US

V. Phone/Fax

Practice location:
  • Phone: 701-418-2600
  • Fax: 701-418-1090
Mailing address:
  • Phone: 701-418-2600
  • Fax: 701-418-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR31931
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: