Healthcare Provider Details

I. General information

NPI: 1487588414
Provider Name (Legal Business Name): AMBER TODD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 2ND AVE N
FARGO ND
58102-4727
US

IV. Provider business mailing address

6250 COUNTY ROAD 23
MCLEOD ND
58057-9213
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3271
  • Fax:
Mailing address:
  • Phone: 701-320-8288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR35490
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: