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General NPI Number Information
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NPI Number | 1740031913
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Entity Type | Organization
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Legal Business Name | CONVENIENT CARE CLINIC, PLLC
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Dates
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Enumeration Date | 03/27/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 505 32ND AVE E
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City | WEST FARGO
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State | ND
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Zip | 58078-8489
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Country | US
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Telephone | 701-532-1731
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Fax |
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Provider Business Mailing Address
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Address Line | 6501 CITY WEST PKWY
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-3248
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Country | US
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Telephone | 952-653-2565
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SUSAN C NORDQUIST
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Credential |
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Telephone | 701-793-1415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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