Healthcare Provider Details

I. General information

NPI: 1114470051
Provider Name (Legal Business Name): BRITTANY NYGAARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY ANDERSON

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 13TH AVE S
FARGO ND
58103-3602
US

IV. Provider business mailing address

2701 13TH AVE S
FARGO ND
58103-3602
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR37763
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: