Individual
MS. ANNE GEORGINA CUSHING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-C
Contact information
Practice address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-3100
Mailing address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-3100
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R14045
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018311
BCBS ND PROVIDER NUMBER
ND
05
—
054519
—
ND
01
—
48B84CU
BCBS MN PROVIDER NUMBER
MN
01
—
500019396
RR MEDICARE PROV NUMBER
ND
Enumeration date
06/14/2006
Last updated
06/07/2012
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