Individual
MRS. MCKENZIE ANN DISRUD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2100 S COLUMBIA RD STE 114, GRAND FORKS, ND 58201-5895
(701) 516-4637
(877) 651-1381
Mailing address
PO BOX 13238, GRAND FORKS, ND 58208-3238
(015) 164-6377
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
F06191893
ND
363LF0000X
Family Nurse Practitioner
Primary
RH1306
ND
Other
Enumeration date
06/21/2019
Last updated
01/30/2025
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