Individual
SIDNEY R JOHNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,CNP
Contact information
Practice address
4110 51ST AVE S, FARGO, ND 58104-7776
(701) 364-3100
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R42226
ND
Other
Enumeration date
03/10/2023
Last updated
03/10/2023
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