Healthcare Provider Details

I. General information

NPI: 1265379739
Provider Name (Legal Business Name): SOUTH EAST EDUCATION COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3170 43RD ST S
FARGO ND
58104-8908
US

IV. Provider business mailing address

3170 43RD ST S
FARGO ND
58104-8908
US

V. Phone/Fax

Practice location:
  • Phone: 701-997-2472
  • Fax:
Mailing address:
  • Phone: 701-997-2472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: KEELY IHRY
Title or Position: DIRECTOR OF STUDENT SERVICES
Credential:
Phone: 701-997-2472