Healthcare Provider Details

I. General information

NPI: 1821472531
Provider Name (Legal Business Name): RACHEL M GRUENBERG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2015
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S BROADWAY
MINOT ND
58701-4636
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-3535
  • Fax: 701-857-5171
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR31946
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: