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General NPI Number Information
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NPI Number | 1003752262
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Entity Type | Organization
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Legal Business Name | ADVANCED CARE CLINIC
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Dates
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Enumeration Date | 04/28/2026
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Last Update Date | 04/28/2026
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Provider Practice Location Address
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Address Line | 682 18TH AVE E STE A
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City | DICKINSON
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State | ND
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Zip | 58601-6320
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Country | US
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Telephone | 701-590-2549
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Fax |
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Provider Business Mailing Address
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Address Line | 682 18TH AVE E STE A
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City | DICKINSON
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State | ND
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Zip | 58601-6320
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Country | US
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Telephone | 701-590-2549
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Fax |
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | CRYSTAL JEAN SULLIVAN
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Credential | FNP-C
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Telephone | 701-590-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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