Healthcare Provider Details

I. General information

NPI: 1962365874
Provider Name (Legal Business Name): AMANDA ANFINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 WILLOW LN SE
MINOT ND
58701-7147
US

IV. Provider business mailing address

3300 WILLOW LN SE
MINOT ND
58701-7147
US

V. Phone/Fax

Practice location:
  • Phone: 701-720-2537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: