Healthcare Provider Details

I. General information

NPI: 1710117312
Provider Name (Legal Business Name): MARISA ANN ALBERTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA ANN UPTON MD

II. Dates (important events)

Enumeration Date: 07/17/2009
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BURDICK EXPY E
MINOT ND
58701
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-7383
  • Fax: 701-857-7013
Mailing address:
  • Phone: 701-857-7817
  • Fax: 701-857-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLT12516
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12516
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: