Healthcare Provider Details

I. General information

NPI: 1699623199
Provider Name (Legal Business Name): KASSANDRA JANE SOFFERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA PETERSON

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

1215 26TH AVE S
MOORHEAD MN
56560-4611
US

V. Phone/Fax

Practice location:
  • Phone: 701-239-3700
  • Fax:
Mailing address:
  • Phone: 218-639-7961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: