Healthcare Provider Details

I. General information

NPI: 1346032398
Provider Name (Legal Business Name): PHILIP MIGUEL AMONCIO SABIDO RN, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2025
Last Update Date: 05/17/2025
Certification Date: 05/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

IV. Provider business mailing address

904 PARK AVE W APT 210
WATFORD CITY ND
58854-3007
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3000
  • Fax: 701-842-6248
Mailing address:
  • Phone: 615-752-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202081
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR50466
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: