Healthcare Provider Details

I. General information

NPI: 1245824838
Provider Name (Legal Business Name): ROBIN PURSIFULL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 4TH AVE NW
MINOT ND
58703-2912
US

IV. Provider business mailing address

3015 16TH ST SW APT 316
MINOT ND
58701-6909
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-0474
  • Fax:
Mailing address:
  • Phone: 850-543-9469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF02210877
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: