Healthcare Provider Details

I. General information

NPI: 1285445213
Provider Name (Legal Business Name): HANNAH LYNN ULVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 21ST AVE S STE 1
FARGO ND
58103-5759
US

IV. Provider business mailing address

1800 21ST AVE S STE 1
FARGO ND
58103-5759
US

V. Phone/Fax

Practice location:
  • Phone: 701-365-8700
  • Fax: 701-365-8701
Mailing address:
  • Phone: 701-365-8700
  • Fax: 701-365-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC1171
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: