Healthcare Provider Details

I. General information

NPI: 1578399044
Provider Name (Legal Business Name): NICHOLAS HUSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 3RD ST NE
MAYVILLE ND
58257-1299
US

IV. Provider business mailing address

315 17TH ST S
MOORHEAD MN
56560-3047
US

V. Phone/Fax

Practice location:
  • Phone: 701-788-2301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1243-26
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: