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General NPI Number Information
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NPI Number | 1821769159
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Entity Type | Organization
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Legal Business Name | NORTH STAR FAMILY CLINIC PLLC
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Dates
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Enumeration Date | 09/27/2021
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 1500 14TH ST W STE 230
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City | WILLISTON
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State | ND
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Zip | 58801-4078
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Country | US
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Telephone | 701-774-0390
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Fax | 701-774-0391
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Provider Business Mailing Address
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Address Line | 3620 6TH AVE E
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City | WILLISTON
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State | ND
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Zip | 58801-6360
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Country | US
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Telephone | 701-774-0390
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Fax | 701-774-0391
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Authorized Official
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Title or Position | OWNER
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Name | BRANDY SHAHIN
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Credential | FNP-C
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Telephone | 701-774-0390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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