Healthcare Provider Details

I. General information

NPI: 1457298663
Provider Name (Legal Business Name): PAIGE NYBO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 BROADWAY N
FARGO ND
58102-4421
US

IV. Provider business mailing address

2618 5TH CT W
WEST FARGO ND
58078-8539
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2535467
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR54449
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: