Healthcare Provider Details

I. General information

NPI: 1124646146
Provider Name (Legal Business Name): LIZA A YSTAAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 13TH ST N
NEW ROCKFORD ND
58356
US

IV. Provider business mailing address

421 14TH ST N
NEW ROCKFORD ND
58356-1103
US

V. Phone/Fax

Practice location:
  • Phone: 701-947-2042
  • Fax: 701-947-2041
Mailing address:
  • Phone: 701-341-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34544
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: