Healthcare Provider Details

I. General information

NPI: 1144002221
Provider Name (Legal Business Name): MELISSA SARAH ANNE GILMORE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 32ND AVE S
GRAND FORKS ND
58201-6071
US

IV. Provider business mailing address

3221 32ND AVE S # A
GRAND FORKS ND
58201-6071
US

V. Phone/Fax

Practice location:
  • Phone: 701-335-4380
  • Fax:
Mailing address:
  • Phone: 701-335-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR33024
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: