Debra K. Vivatson, MSN ACNP-C
Individual provider Active NPI Acute Care Nurse Practitioner · Cavalier, ND
NPI 1720355233 · NPPES record last updated Oct 11, 2012
Key facts
- NPI
- 1720355233
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- R22555 (ND)
- Practice address
- 201 East 3Rd Ave S
Cavalier, ND 58220 - Phone
- (701) 780-5000
- NPI assigned
- Nov 29, 2011
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120517000011 | ND | Practitioner - Nurse Practitioner | 5991968638 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6783 | WI | MD | Occupational Therapist |
| R22555 | ND | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cavalier County Memorial Hospital Association | Current |
Accepting new patients | |
| Avera St Lukes | Current | Accepting new patients | |
| Avera St. Luke'S | Current |
Accepting new patients | |
| Mercy Hospital of Devils Lake | Current | Accepting new patients | |
| Avera St. Lukes | Current |
Accepting new patients | |
| Cavalier County Memorial Hospital Association | Past | Accepting new patients |
Locations
425 College Dr S
Ste 14
Devils Lake, ND 58301
Phone (701) 662-8662
1031 7th St NE
Devils Lake, ND 58301
Phone (701) 662-2131
909 2nd St
Langdon, ND 58249
Phone (701) 256-6100
901 2nd St
Langdon, ND 58249
Phone (701) 256-6100
301 5th St
Walhalla, ND 58282
Phone (701) 549-2711
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | R22555 | ND | Yes |
Addresses
Primary practice location
201 East 3Rd Ave S
Cavalier, ND 58220
Mailing address
PO Box 6002
Grand Forks, ND 58206-6002
Phone (701) 780-5000
Other providers in Cavalier, ND
- Kulvinder Sumra
- Derek Allan Sundby
- Swanson Eye Clinic, PC
- Susan J Thompson
- Thomas Vela
- White Drug Co of Jamestown Inc
- Christie Lee Winkler
All providers in Cavalier, ND · Acute Care Nurse Practitioner in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.