Healthcare Provider Details

I. General information

NPI: 1174400659
Provider Name (Legal Business Name): BERNADINE WHITESHIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 BELLILE ST UNIT 401
SAINT MICHAEL ND
58370-7008
US

IV. Provider business mailing address

PO BOX 221
SAINT MICHAEL ND
58370-0221
US

V. Phone/Fax

Practice location:
  • Phone: 701-230-2852
  • Fax:
Mailing address:
  • Phone: 701-230-2852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: