1558581900 NPI number — MRS. NADINE F HOLMSTROM RPH

Table of content: MRS. NADINE F HOLMSTROM RPH (NPI 1558581900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558581900 NPI number — MRS. NADINE F HOLMSTROM RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLMSTROM
Provider First Name:
NADINE
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558581900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 RIDGELAND LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58503-6297
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-222-1022
Provider Business Mailing Address Fax Number:
701-663-1880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 1ST ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANDAN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58554-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-663-5188
Provider Business Practice Location Address Fax Number:
701-663-1880
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  4201 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com