Healthcare Provider Details

I. General information

NPI: 1881347136
Provider Name (Legal Business Name): SUZANNE OURADNIK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 25TH ST S
FARGO ND
58103-2367
US

IV. Provider business mailing address

1240 25TH ST S
FARGO ND
58103-2367
US

V. Phone/Fax

Practice location:
  • Phone: 701-241-8187
  • Fax:
Mailing address:
  • Phone: 701-241-8189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberR41468
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: