Healthcare Provider Details

I. General information

NPI: 1356426415
Provider Name (Legal Business Name): DEBORAH NELSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 3RD AVE N
FARGO ND
58102-4811
US

IV. Provider business mailing address

401 3RD AVE N
FARGO ND
58102-4811
US

V. Phone/Fax

Practice location:
  • Phone: 701-241-1360
  • Fax: 701-241-8559
Mailing address:
  • Phone: 701-241-1360
  • Fax: 701-241-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR21288
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: