Provider Demographics
NPI:1205407780
Name:PIATZ, PAYTON (DNP, FNP)
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:
Last Name:PIATZ
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:PAYTON
Other - Middle Name:
Other - Last Name:BORUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3201 33RD ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8823
Mailing Address - Country:US
Mailing Address - Phone:701-364-4467
Mailing Address - Fax:701-365-0727
Practice Address - Street 1:3201 33RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8823
Practice Address - Country:US
Practice Address - Phone:701-364-4467
Practice Address - Fax:701-365-0727
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR43458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily