Healthcare Provider Details

I. General information

NPI: 1407685415
Provider Name (Legal Business Name): NORTH DAKOTA CENTER FOR WEIGHT MANAGEMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 45TH ST S STE B
FARGO ND
58104-8955
US

IV. Provider business mailing address

3501 45TH ST S STE B
FARGO ND
58104-8955
US

V. Phone/Fax

Practice location:
  • Phone: 701-807-0684
  • Fax: 833-605-4039
Mailing address:
  • Phone: 701-807-0684
  • Fax: 833-605-4039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RACHEL L FALEIDE
Title or Position: DNP, FNP-C
Credential:
Phone: 701-807-0684