Provider Demographics
NPI:1518720408
Name:GIANT STRIDES HEALTHCARE LLC
Entity Type:Organization
Organization Name:GIANT STRIDES HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NWACHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-491-2879
Mailing Address - Street 1:3509 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7767
Mailing Address - Country:US
Mailing Address - Phone:701-491-2879
Mailing Address - Fax:
Practice Address - Street 1:3509 47TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7767
Practice Address - Country:US
Practice Address - Phone:701-491-2879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service