Healthcare Provider Details

I. General information

NPI: 1689475717
Provider Name (Legal Business Name): INDIA STOCKERT M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INDIA BERCIER

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 VIVIAN ST W
PARK RIVER ND
58270-4540
US

IV. Provider business mailing address

3501 UNIVERSITY AVE STOP 8357
GRAND FORKS ND
58202-6105
US

V. Phone/Fax

Practice location:
  • Phone: 701-284-7500
  • Fax:
Mailing address:
  • Phone: 701-777-2346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: