Provider Demographics
NPI:1578127080
Name:FROSLIE, DESIREE (NP)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:
Last Name:FROSLIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:
Other - Last Name:MCEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 26TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-6615
Mailing Address - Country:US
Mailing Address - Phone:701-371-4144
Mailing Address - Fax:
Practice Address - Street 1:801 BROADWAY N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-3641
Practice Address - Country:US
Practice Address - Phone:701-234-2241
Practice Address - Fax:701-234-4877
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR30582363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology