Healthcare Provider Details

I. General information

NPI: 1831110055
Provider Name (Legal Business Name): NINA C SJOQUIST NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 4TH ST N PO BOX MC
FARGO ND
58102-4539
US

IV. Provider business mailing address

820 4TH STREET N
FARGO ND
58122-0001
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6161
  • Fax: 701-234-3861
Mailing address:
  • Phone: 701-234-6161
  • Fax: 701-234-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 173463-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR19519
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: