Healthcare Provider Details

I. General information

NPI: 1841377264
Provider Name (Legal Business Name): NATALYA U BRONSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 4TH STREET S
FARGO ND
58107-2027
US

IV. Provider business mailing address

510 4TH STREET S
FARGO ND
58107-2027
US

V. Phone/Fax

Practice location:
  • Phone: 701-476-7220
  • Fax: 701-280-5795
Mailing address:
  • Phone: 701-476-7220
  • Fax: 701-280-5795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10082
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: