MEDICARE: LONDON HERBERT APRN, FNP-C

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
1	208D00000X	General Practice Physician	R43308	ND
2	363L00000X	Nurse Practitioner	R43308	ND

General Provider Information

NPI Number	:	1730873829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONDON HERBERT APRN, FNP-C

Provider Business Mailing Address
First Line	:	1108 15TH AVE SW
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-6804
Country	:	US
Telephone Number	:	701-840-8698
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 N MAIN ST
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-7308
Country	:	US
Telephone Number	:	701-444-2888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2023
Last Update Date	:	10/13/2023

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