Provider Demographics
NPI:1013220490
Name:FENNERN, TRISHA J (NP-C)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:J
Last Name:FENNERN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 20TH AVE SW STE 113
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6487
Mailing Address - Country:US
Mailing Address - Phone:701-837-1551
Mailing Address - Fax:701-837-1540
Practice Address - Street 1:1021 20TH AVE SW STE 113
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6487
Practice Address - Country:US
Practice Address - Phone:701-837-1551
Practice Address - Fax:701-837-1540
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84427Medicaid