Healthcare Provider Details

I. General information

NPI: 1285583138
Provider Name (Legal Business Name): BHAKTA BDR TIWARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 10/15/2026
Certification Date: 10/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 14TH AVE E STE 208B
WEST FARGO ND
58078-3363
US

IV. Provider business mailing address

1042 14TH AVE E STE 208B
WEST FARGO ND
58078-3363
US

V. Phone/Fax

Practice location:
  • Phone: 701-809-8497
  • Fax:
Mailing address:
  • Phone: 702-336-4385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number927
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number28
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberNDL188042
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: