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General NPI Number Information
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NPI Number | 1306638689
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Entity Type | Organization
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Legal Business Name | NICOLE BETTENDORF PLLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 1218 DELANO AVE
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City | WALHALLA
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State | ND
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Zip | 58282-4113
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Country | US
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Telephone | 763-233-8584
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Fax |
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Provider Business Mailing Address
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Address Line | 714 5TH ST
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City | LANGDON
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State | ND
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Zip | 58249-2536
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Country | US
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Telephone | 763-233-8584
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | NICOLE BETTENDORF
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Credential | FNP
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Telephone | 763-233-8584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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