Healthcare Provider Details

I. General information

NPI: 1144852070
Provider Name (Legal Business Name): ANGELA R EKBLAD NP/RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 4TH STREET EAST
WILLISTON ND
58801-5350
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 701-847-3771
  • Fax: 701-842-4025
Mailing address:
  • Phone: 701-842-3771
  • Fax: 701-842-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR42287
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2019095578
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: