Healthcare Provider Details

I. General information

NPI: 1972327039
Provider Name (Legal Business Name): DANA KITSCH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/14/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST S N
FARGO ND
58104
US

IV. Provider business mailing address

2101 ELM ST S N
FARGO ND
58104
US

V. Phone/Fax

Practice location:
  • Phone: 701-541-6912
  • Fax:
Mailing address:
  • Phone: 701-541-6912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR24394
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: