Provider Demographics
NPI:1720397003
Name:NISHEK, STEPHANIE J (ND)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:J
Last Name:NISHEK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4525
Mailing Address - Country:US
Mailing Address - Phone:701-258-9418
Mailing Address - Fax:701-258-9423
Practice Address - Street 1:705 E MAIN AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4525
Practice Address - Country:US
Practice Address - Phone:701-258-9418
Practice Address - Fax:701-258-9423
Is Sole Proprietor?:No
Enumeration Date:2010-10-04
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2014-01175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath