Healthcare Provider Details

I. General information

NPI: 1720683816
Provider Name (Legal Business Name): CHRISTINA A PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E STE 201
MINOT ND
58701-4769
US

IV. Provider business mailing address

919 3RD ST NE
MINOT ND
58703-2437
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7900
  • Fax:
Mailing address:
  • Phone: 701-509-3939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTECH1598
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: