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NPI Code Detail

MEDICARE: DOLORES I VAN BOURGONDIEN ANP-BC

MEDICARE: DOLORES I VAN BOURGONDIEN ANP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerARNP9239798FL
2363LP0808XPsychiatric/Mental Health Nurse PractitionerR54243ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457788390
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOLORES I VAN BOURGONDIEN ANP-BC
Provider Business Mailing Address
First Line : PO BOX 5210
Second Line :
City : GRAND FORKS
State : ND
Zip : 58206-5210
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3674 S WASHINGTON ST
Second Line :
City : GRAND FORKS
State : ND
Zip : 58201-5766
Country : US
Telephone Number : 701-205-3000
Fax Number : 701-732-2501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2013
Last Update Date : 01/27/2026

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Directions to “ DOLORES I VAN BOURGONDIEN ANP-BC” Practice Location

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