Healthcare Provider Details

I. General information

NPI: 1184694127
Provider Name (Legal Business Name): MICHELLE JOY FUNDINGSLAND RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE JOY TORNO RD

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E FL 1
MINOT ND
58701-4768
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-2850
  • Fax: 701-857-5593
Mailing address:
  • Phone: 701-857-2850
  • Fax: 701-857-5593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number678
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: