Individual
KOREE VIVATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,CNP
Contact information
Practice address
1401 13TH AVE E, WEST FARGO, ND 58078-3468
(701) 364-5751
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
7760
MN
363LF0000X
Family Nurse Practitioner
Primary
R41374
ND
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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