Individual provider Active NPI

Queen Elizabeth Fugah, DNP

  • Family Nurse Practitioner
  • Williston, ND
National Provider Identifier
1619850831
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
202964 Issued in ND
Practice address
1213 15TH Ave W
Williston, ND 58801-3800
Phone
(701) 572-7651
NPI assigned
Jul 26, 2025
Last updated
Jul 28, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 202964 ND Primary

Addresses

Primary practice location

1213 15TH Ave W
Williston, ND 58801-3800

Mailing address

13785 Marions Ridge Rd
Williston, ND 58801-9589
Phone (850) 319-6666

Other practice location 1

1213 15th Ave W
Williston, ND 58801-3800
Phone (701) 572-7651

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250915003487 ND Practitioner - Nurse Practitioner 4183127061 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Medical CenterGroup PAC ID 7416851381, shared by 2 NPIs, 78 clinicians

Practice addresses (Care Compare)

1213 15TH Ave W
Williston, ND 58801-3895
Phone (701) 572-7651

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
202964NDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Medical Center CurrentSince Sep 2, 2025 Accepting new patients
Mercy Medical Center Current Accepting new patients
Mercy Home Care CurrentSince Sep 2, 2025 Accepting new patients
Mercy Medical Center Current Accepting new patients

Locations

3369 Solutions Ctr
Chicago, IL 60677

1213 15th Ave W
Williston, ND 58801
Phone (701) 572-7641

1301 15th Ave W
Williston, ND 58801
Phone (701) 774-7400

Interoperability endpoints

  • Direct secure messaging: queenelizabethfugah@normd.allscriptsdirect.net

Organizations & group practices 4

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1619850831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13785 MARIONS RIDGE RD",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588019589",
            "telephone_number": "850-319-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 15TH AVE W",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588013800",
            "telephone_number": "701-572-7651"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1213 15th Ave W",
            "address_purpose": "LOCATION",
            "city": "Williston",
            "state": "ND",
            "postal_code": "588013800",
            "country_code": "US",
            "telephone_number": "701-572-7651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUGAH",
        "first_name": "QUEEN ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-26",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ND",
            "license": "202964",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williston, ND

Sources for this page

Verify at the official NPI Registry.