Healthcare Provider Details

I. General information

NPI: 1922067305
Provider Name (Legal Business Name): UNIVERSITY NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCCANNEL HALL ROOM 100 2891 2ND AVENUE NORTH STOP 9038
GRAND FORKS ND
58202-9038
US

IV. Provider business mailing address

MCCANNEL HALL ROOM 100 2891 2ND AVENUE NORTH STOP 9038
GRAND FORKS ND
58202-9038
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-4500
  • Fax: 701-777-4835
Mailing address:
  • Phone: 701-777-4500
  • Fax: 701-777-4835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATRINA LANDMAN
Title or Position: ADMIN
Credential:
Phone: 701-777-4845