Healthcare Provider Details

I. General information

NPI: 1720942139
Provider Name (Legal Business Name): SIERRA ALIEDA TERGESEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S STE 4
FARGO ND
58103-5804
US

IV. Provider business mailing address

2400 32ND AVE S STE 4
FARGO ND
58103-5804
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-9912
  • Fax: 701-297-0807
Mailing address:
  • Phone: 701-234-9912
  • Fax: 701-297-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number49177
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: