Healthcare Provider Details

I. General information

NPI: 1275001992
Provider Name (Legal Business Name): HEIDI SELZLER-ECHOLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 4TH ST S STE 608
FARGO ND
58103-1940
US

IV. Provider business mailing address

1111 6TH ST S
FARGO ND
58103-2746
US

V. Phone/Fax

Practice location:
  • Phone: 701-264-5200
  • Fax: 701-999-2779
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR41396
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: