Active NPI
Nicole Antonia Hagstrom
- Registered Dietitian
- West Fargo, ND
National Provider Identifier
1578478566
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 833
- Practice address
- 4418 12TH St W
West Fargo, ND 58078-8828 - Phone
- (701) 640-4571
- NPI assigned
- Aug 17, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 833 | ND | Primary |
Addresses
Primary practice location
4418 12TH St W
West Fargo, ND 58078-8828
Mailing address
4418 12TH St W
West Fargo, ND 58078-8828
Phone (701) 640-4571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1786924800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1578478566",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4418 12TH ST W",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580788828",
"telephone_number": "701-640-4571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4418 12TH ST W",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580788828",
"telephone_number": "701-640-4571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGSTROM",
"first_name": "NICOLE",
"middle_name": "ANTONIA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-08-17",
"last_updated": "2026-08-17",
"certification_date": "2026-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "ND",
"license": "833",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.