Van Bourgondien, Dolores I

Van Bourgondien, Dolores I is an sole proprietor health care provider with primary practice located at 4700 S Washington St Ste G , Grand Forks ND 58201-8155. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, Physician Assistants & Advanced Practice Nursing Providers / Adult Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Van Bourgondien, Dolores I can be contacted via phone (701) 205-3000.

Contact Information

Primary practice address
4700 S Washington St Ste G Grand Forks ND 58201-8155
Phone: (701) 205-3000
Fax: (701) 732-2501
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X R54243 North Dakota
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X ARNP9239798 Florida

Profile Details

NPI number 1457788390
LBN Legal business name Van Bourgondien, Dolores I
Credentials ANP-BC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 10th, 2013
Last updated Jul 18th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457788390 NPPES
Florida MEDICAID 010140700

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