=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295565620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISANN MARIE RICHTER DNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2024
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 S MAIN AVE
-----------------------------------------------------
City | RUGBY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58368-2118
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-425-3781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1424 N 16TH ST
-----------------------------------------------------
City | BISMARCK
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58501-2848
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-425-3781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | 200475
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------