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Individual

DOREEN JOAN GIGSTAD-STAVE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2261
(701) 234-2080
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2261
(701) 234-2080

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0028
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
307195200
MN
05
71097
ND
Enumeration date
07/16/2006
Last updated
10/16/2012
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