Healthcare Provider Details

I. General information

NPI: 1326048232
Provider Name (Legal Business Name): CONDETTA NESS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 11/29/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 N PARK ST
NORTHWOOD ND
58267-4102
US

IV. Provider business mailing address

PO BOX 190
NORTHWOOD ND
58267-0190
US

V. Phone/Fax

Practice location:
  • Phone: 701-587-6060
  • Fax: 701-587-6009
Mailing address:
  • Phone: 701-587-6060
  • Fax: 701-587-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR18461
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR18461
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0060
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: