Healthcare Provider Details

I. General information

NPI: 1033899745
Provider Name (Legal Business Name): TAYLOR STECKLER ECKART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 02/20/2025
Certification Date: 07/19/2023
Deactivation Date: 11/01/2023
Reactivation Date: 02/20/2025

III. Provider practice location address

1830 18TH ST S
FARGO ND
58103-4702
US

IV. Provider business mailing address

1830 18TH ST S
FARGO ND
58103-4702
US

V. Phone/Fax

Practice location:
  • Phone: 701-526-0187
  • Fax:
Mailing address:
  • Phone: 701-526-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR51799
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: