Healthcare Provider Details

I. General information

NPI: 1700954633
Provider Name (Legal Business Name): CHARLES D NYHUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 LINCOLN AVE
HARVEY ND
58341-1524
US

IV. Provider business mailing address

922 LINCOLN AVE
HARVEY ND
58341-1524
US

V. Phone/Fax

Practice location:
  • Phone: 701-324-4856
  • Fax: 701-324-4858
Mailing address:
  • Phone: 701-324-4856
  • Fax: 701-324-4858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4406
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: