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Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Grand Forks, ND

NPI 1194417907 · NPPES record last updated Oct 23, 2025

Key facts

NPI
1194417907
Entity type
Individual (NPI type 1)
Primary specialty
Student in an Organized Health Care Education/Training Program 390200000X
Practice address
231 Centennial Dr Stop 7189
Grand Forks, ND 58202-7189
Phone
(701) 777-0826
NPI assigned
May 22, 2023
Sex
Female
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Fraser Child and Family Center Current
since May 28, 2023		 Accepting new patients
Fraser Past
since May 28, 2023		 Accepting new patients

Locations

3333 University Ave SE
Minneapolis, MN 55414
Phone (612) 253-1139

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X ND Yes

Addresses

Primary practice location

231 Centennial Dr Stop 7189
Grand Forks, ND 58202-7189

Mailing address

231 Centennial Dr Stop 7189
Grand Forks, ND 58202-7189
Phone (701) 777-0826

Other providers in Grand Forks, ND

All providers in Grand Forks, ND · Student in an Organized Health Care Education/Training Program in North Dakota

Sources for this page

Verify at the official NPI Registry.