Healthcare Provider Details

I. General information

NPI: 1487575692
Provider Name (Legal Business Name): SHERYLL DIANE PAULSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9801 HIGHWAY 52 S
MINOT ND
58701-2426
US

IV. Provider business mailing address

9801 HIGHWAY 52 S
MINOT ND
58701-2426
US

V. Phone/Fax

Practice location:
  • Phone: 701-833-1660
  • Fax:
Mailing address:
  • Phone: 701-833-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberPAU712949
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: