=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346032398
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP MIGUEL AMONCIO SABIDO RN, APRN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2025
-----------------------------------------------------
Last Update Date | 05/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 709 4TH AVE NE
-----------------------------------------------------
City | WATFORD CITY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58854-7628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-842-3000
-----------------------------------------------------
Fax | 701-842-6248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 904 PARK AVE W APT 210
-----------------------------------------------------
City | WATFORD CITY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58854-3007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-752-0885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | R50466
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 202081
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------