Individual provider Active NPI

Hannah Marie Pavek, DNP, APRN, CPNP-PC

  • Pediatric Nurse Practitioner
  • Fargo, ND
National Provider Identifier
1821612433
Registry record updated Jan 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
R42721 Issued in ND
Practice address
100 4TH St S Ste 308
Fargo, ND 58103-1937
Phone
(701) 367-2165
NPI assigned
May 31, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X R42721 ND
Pediatric Registered Nurse 163WP0200X 2464309 MN
Pediatric Nurse Practitioner 363LP0200X R42721 ND Primary

Addresses

Primary practice location

100 4TH St S Ste 308
Fargo, ND 58103-1937

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074
Phone (605) 328-6585

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
I20211028003156 ND Practitioner - Nurse Practitioner 8921496696 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2464309MNMDPediatric Registered Nurse
R42721NDMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Pediatrics CurrentSince Jul 24, 2021 Accepting new patients
Sanford Medical Center Fargo CurrentSince Jul 24, 2021 Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

801 Broadway N
Fargo, ND 58102
Phone (701) 234-5121

4656 40th Ave S
Ste 214
Fargo, ND 58104
Phone (701) 234-3725

736 Broadway N
Fargo, ND 58102
Phone (701) 234-2353

100 4th St S
Fargo, ND 58103
Phone (701) 234-4141

100 4th St S
Ste 308
Fargo, ND 58103
Phone (701) 234-4585

1720 University Dr S
Fargo, ND 58103
Phone (701) 280-4140

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1590883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1821612433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074",
            "telephone_number": "605-328-6585",
            "fax_number": "605-312-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 4TH ST S STE 308",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031937",
            "telephone_number": "701-367-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVEK",
        "first_name": "HANNAH",
        "middle_name": "MARIE",
        "credential": "DNP, APRN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-31",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "ND",
            "license": "R42721",
            "primary": false
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "MN",
            "license": "2464309",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "ND",
            "license": "R42721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

Verify at the official NPI Registry.