Healthcare Provider Details

I. General information

NPI: 1467527820
Provider Name (Legal Business Name): CHERYL D ULVEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 1ST ST N
NEW TOWN ND
58763
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-2990
  • Fax: 701-627-2910
Mailing address:
  • Phone: 701-857-5650
  • Fax: 701-857-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC1053
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: