Healthcare Provider Details

I. General information

NPI: 1972066256
Provider Name (Legal Business Name): TREVOR DENNIS STAVIG NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3345 39TH ST S STE 1
FARGO ND
58104-7539
US

IV. Provider business mailing address

820 LOHSTRETER RD
MANDAN ND
58554-2302
US

V. Phone/Fax

Practice location:
  • Phone: 877-522-1275
  • Fax: 833-888-7145
Mailing address:
  • Phone: 701-527-3226
  • Fax: 701-584-9900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR38941
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR38941
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: