Individual
NICOLE EGSTAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2302 30TH AVE S APT 514, GRAND FORKS, ND 58201-6506
(701) 314-0103
Mailing address
449 HARVEY AVE, MINTO, ND 58261-6102
(701) 314-0103
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1474415
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1474415
—
ND
Enumeration date
11/30/2020
Last updated
11/30/2020
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