Individual
MS. NICOLE ANVINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Mailing address
2424 32ND AVE S, STE 202, GRAND FORKS, ND 58201-6545
(701) 746-6336
(701) 772-1030
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
9504
MN
363A00000X
Physician Assistant
Primary
PAC0232
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1453358
—
ND
01
—
18686
ND BC/BS
ND
05
—
243620500
—
MN
01
—
80D90AV
MN BC/BS
MN
Enumeration date
04/25/2006
Last updated
01/23/2017
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