1154091916 NPI number — HILLARY M NEWBORG APRN,CNP

Table of content: HILLARY M NEWBORG APRN,CNP (NPI 1154091916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154091916 NPI number — HILLARY M NEWBORG APRN,CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWBORG
Provider First Name:
HILLARY
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN,CNP
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:
1154091916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1702 UNIVERSITY DR S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103-4940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-364-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LISBON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58054-4244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-693-4134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2021

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: 363LF0000X , with the licence number:  R39053 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: R39053 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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