Healthcare Provider Details

I. General information

NPI: 1326454000
Provider Name (Legal Business Name): NYLA WOITTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COLLINS AVE
MANDAN ND
58554-2067
US

IV. Provider business mailing address

1200 COLLINS AVE
MANDAN ND
58554-2067
US

V. Phone/Fax

Practice location:
  • Phone: 701-663-5373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR35818
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: