Healthcare Provider Details

I. General information

NPI: 1295770857
Provider Name (Legal Business Name): MARIT K HORDVIK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 CENTENNIAL BLVD
FARGO ND
58102-6050
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-231-7331
  • Fax: 701-231-6132
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6315
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: