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General NPI Number Information
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NPI Number | 1760496020
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Entity Type | Organization
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Legal Business Name | ADULT AND FAMILY CLINIC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1100 WEISS AVE
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City | BISMARCK
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State | ND
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Zip | 58503-0539
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Country | US
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Telephone | 701-222-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 WEISS AVE
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City | BISMARCK
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State | ND
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Zip | 58503-0539
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Country | US
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Telephone | 701-222-1300
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. HEATHER LEIER
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Credential | NP-C
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Telephone | 701-222-1300
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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 | R26704
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License Number State | ND
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