Healthcare Provider Details

I. General information

NPI: 1093069551
Provider Name (Legal Business Name): ROBIN FIDDLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN BELGARDE RN

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 74TH AVE NE
FORT TOTTEN ND
58335
US

IV. Provider business mailing address

PO BOX 309
FORT TOTTEN ND
58335-0309
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1600
  • Fax:
Mailing address:
  • Phone: 701-766-1600
  • Fax: 701-766-1624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR34899
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: