Provider Demographics
NPI:1437565330
Name:DAHL, CHRISTINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:DAHL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MJONESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3453 INTERSTATE BLVD S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2257
Mailing Address - Country:US
Mailing Address - Phone:701-205-4533
Mailing Address - Fax:701-205-4593
Practice Address - Street 1:1665 43RD ST S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3316
Practice Address - Country:US
Practice Address - Phone:701-289-5469
Practice Address - Fax:701-540-9824
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26447363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84359Medicaid