Healthcare Provider Details

I. General information

NPI: 1871389825
Provider Name (Legal Business Name): HEATHER PFAFF PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 33RD ST S
FARGO ND
58104-8823
US

IV. Provider business mailing address

3853 HIGHWAY 10
TAPPEN ND
58487-9439
US

V. Phone/Fax

Practice location:
  • Phone: 701-365-4488
  • Fax: 701-365-0727
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR34429
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202661
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: