Healthcare Provider Details

I. General information

NPI: 1205407780
Provider Name (Legal Business Name): PAYTON PIATZ DNP, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAYTON BORUD

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 33RD ST S
FARGO ND
58104-8823
US

IV. Provider business mailing address

3201 33RD ST S
FARGO ND
58104-8823
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-4467
  • Fax: 701-365-0727
Mailing address:
  • Phone: 701-364-4467
  • Fax: 701-365-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR43458
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: