Healthcare Provider Details

I. General information

NPI: 1750634622
Provider Name (Legal Business Name): NICOLE MARIE WINDJUE GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 05/14/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

2101 ELM ST N
FARGO ND
58102-2417
US

V. Phone/Fax

Practice location:
  • Phone: 701-461-7341
  • Fax:
Mailing address:
  • Phone: 701-461-7341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR29084
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: