Healthcare Provider Details

I. General information

NPI: 1356788277
Provider Name (Legal Business Name): ANDREA HILLSTAD ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4133 30TH AVE S STE 104
FARGO ND
58104-8421
US

IV. Provider business mailing address

4133 30TH AVE S STE 104
FARGO ND
58104-8421
US

V. Phone/Fax

Practice location:
  • Phone: 701-314-4008
  • Fax: 701-829-7247
Mailing address:
  • Phone: 701-314-4008
  • Fax: 701-829-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2016-03
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: