Individual
BONNIE S KVISTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3620
Mailing address
2701 13TH AVE S, FARGO, ND 58103-3602
(701) 234-3620
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
11205
ND
208000000X
Pediatrics Physician
49784
MN
208000000X
Pediatrics Physician
PT11205
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
724690000
—
MN
Enumeration date
03/30/2007
Last updated
03/25/2022
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