Healthcare Provider Details

I. General information

NPI: 1265380232
Provider Name (Legal Business Name): OPTIMUM HEALTH & WELLNESS CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 MAIN ST W
HAZEN ND
58545-4211
US

IV. Provider business mailing address

321 MAIN ST W
HAZEN ND
58545-4211
US

V. Phone/Fax

Practice location:
  • Phone: 701-421-7986
  • Fax:
Mailing address:
  • Phone: 701-421-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA KAY WEISZ
Title or Position: APRN, FNP-C
Credential:
Phone: 701-421-7986