Provider Demographics
NPI:1144105198
Name:NOBORU, FATIMA YESTARO IV (DOC)
Entity type:Individual
Prefix:MS
First Name:FATIMA
Middle Name:YESTARO
Last Name:NOBORU
Suffix:IV
Gender:M
Credentials:DOC
Other - Prefix:MRS
Other - First Name:FATIMA
Other - Middle Name:YESTARO
Other - Last Name:NOBORU
Other - Suffix:IV
Other - Last Name Type:Former Name
Other - Credentials:DOC
Mailing Address - Street 1:2700 HAWKEN ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1361
Mailing Address - Country:US
Mailing Address - Phone:701-319-3504
Mailing Address - Fax:701-319-3504
Practice Address - Street 1:2700 HAWKEN ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1361
Practice Address - Country:US
Practice Address - Phone:701-319-3504
Practice Address - Fax:701-319-3504
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant