Healthcare Provider Details

I. General information

NPI: 1124739263
Provider Name (Legal Business Name): JOAN QUAM APRN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 NODAK DR S
FARGO ND
58103-2333
US

IV. Provider business mailing address

2401 41ST ST S STE 101
FARGO ND
58104-7783
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-6224
  • Fax: 701-232-4687
Mailing address:
  • Phone: 701-551-6980
  • Fax: 701-551-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR44324
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: