Healthcare Provider Details

I. General information

NPI: 1760759302
Provider Name (Legal Business Name): BROOKE MAATZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

PO BOX 2010
FARGO ND
58122-0605
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR33381
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: