Healthcare Provider Details

I. General information

NPI: 1255275608
Provider Name (Legal Business Name): MOLLIE JEAN STUBSTAD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 6TH ST SE
STANLEY ND
58784-4444
US

IV. Provider business mailing address

4413 87TH DR NW
NEW TOWN ND
58763-9125
US

V. Phone/Fax

Practice location:
  • Phone: 701-628-2424
  • Fax:
Mailing address:
  • Phone: 701-430-6933
  • Fax: 701-430-6933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR42830
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: