Healthcare Provider Details

I. General information

NPI: 1013832187
Provider Name (Legal Business Name): CORINNA ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 CHESTNUT ST
GRAND FORKS ND
58201-8020
US

IV. Provider business mailing address

401 N 12TH ST APT 4
GRAND FORKS ND
58203-3165
US

V. Phone/Fax

Practice location:
  • Phone: 701-741-5462
  • Fax:
Mailing address:
  • Phone: 701-517-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: