Healthcare Provider Details

I. General information

NPI: 1588324941
Provider Name (Legal Business Name): JESSICA VECHINI MIRANDA ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 43RD ST S STE 106
FARGO ND
58103-3579
US

IV. Provider business mailing address

1635 43RD ST S STE 106
FARGO ND
58103-3579
US

V. Phone/Fax

Practice location:
  • Phone: 701-347-1322
  • Fax: 202-992-6619
Mailing address:
  • Phone: 701-347-1322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number81
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1165-PA
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1151
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number2025-02
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: