Provider Demographics
NPI:1447896170
Name:DIABETES CARE CLINIC PLLC
Entity type:Organization
Organization Name:DIABETES CARE CLINIC PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:701-540-9822
Mailing Address - Street 1:3453 INTERSTATE BLVD S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2257
Mailing Address - Country:US
Mailing Address - Phone:701-289-5469
Mailing Address - Fax:701-205-4593
Practice Address - Street 1:1665 43RD ST S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3316
Practice Address - Country:US
Practice Address - Phone:701-540-9822
Practice Address - Fax:701-540-9824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty