Individual
KELLIE WEISENBURGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
87 LINCOLN AVE, UNDERWOOD, ND 58576
(701) 442-3148
(701) 442-3414
Mailing address
PO BOX 253, UNDERWOOD, ND 58576-0253
(701) 442-3148
(701) 442-3414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R25051
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007
AMERICA'S PPO
—
01
—
025563
BCBS
ND
01
—
025564
BCBS
ND
05
—
19789
—
ND
01
—
A63211044293
PREFERRED ONE
—
01
—
P00300571
RR MEDICARE
—
Enumeration date
10/17/2005
Last updated
02/15/2008
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