Healthcare Provider Details

I. General information

NPI: 1306456470
Provider Name (Legal Business Name): DARCY THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

2400 32ND AVE S
FARGO ND
58103-5800
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-7980
  • Fax: 701-234-3838
Mailing address:
  • Phone: 701-234-7980
  • Fax: 701-234-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberR28838
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: