Healthcare Provider Details

I. General information

NPI: 1083072466
Provider Name (Legal Business Name): KARI GUDMUNDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 44TH AVE S STE F
GRAND FORKS ND
58201-3434
US

IV. Provider business mailing address

1451 44TH AVE S STE F
GRAND FORKS ND
58201-3434
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-2633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4463
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR42729
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: