Healthcare Provider Details

I. General information

NPI: 1194778035
Provider Name (Legal Business Name): NORTHERN VALLEY OBSTETRICS & GYNECOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 17TH AVE S
GRAND FORKS ND
58201-4010
US

IV. Provider business mailing address

2810 17TH AVE S
GRAND FORKS ND
58201-4010
US

V. Phone/Fax

Practice location:
  • Phone: 701-738-2004
  • Fax:
Mailing address:
  • Phone: 701-738-2004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number8135
License Number StateND

VIII. Authorized Official

Name: RORY TROTTIER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 701-738-2004