Healthcare Provider Details

I. General information

NPI: 1417932823
Provider Name (Legal Business Name): MEREDITH K KELSEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEREDITH K CLINE NP

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 9TH AVE E
LISBON ND
58054
US

IV. Provider business mailing address

10 9TH AVE E
LISBON ND
58054
US

V. Phone/Fax

Practice location:
  • Phone: 701-683-4711
  • Fax: 701-683-3205
Mailing address:
  • Phone: 701-683-4711
  • Fax: 701-683-3205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR27855
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: