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General NPI Number Information
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NPI Number | 1275443921
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Entity Type | Individual
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Provider Name | IVY BELLE BROSSEAU APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 2100 S COLUMBIA RD STE 114
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City | GRAND FORKS
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State | ND
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Zip | 58201-5895
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Country | US
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Telephone | 701-220-1362
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Fax |
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Provider Business Mailing Address
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Address Line | 5408 TITANIUM DR
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City | BISMARCK
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State | ND
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Zip | 58503-6977
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Country | US
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Telephone | 701-220-1362
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 205957
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License Number State | ND
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