Healthcare Provider Details

I. General information

NPI: 1376950782
Provider Name (Legal Business Name): ELIZABETH SANDBERG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 07/17/2014
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: 701-587-6900
  • Fax: 701-587-6104
Mailing address:
  • Phone: 701-587-6900
  • Fax: 701-587-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34501
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: