Healthcare Provider Details

I. General information

NPI: 1730014028
Provider Name (Legal Business Name): ERIN ELIZABETH BOTHUN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 S 4TH ST
GRAND FORKS ND
58201-4777
US

IV. Provider business mailing address

212 S 4TH ST
GRAND FORKS ND
58201-4777
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-2100
  • Fax:
Mailing address:
  • Phone: 701-757-5100
  • Fax: 701-757-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14404
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2509343
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205466
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR51629
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: