Provider Demographics
NPI:1760496020
Name:ADULT AND FAMILY CLINIC
Entity Type:Organization
Organization Name:ADULT AND FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIER
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:701-222-1300
Mailing Address - Street 1:1100 WEISS AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0539
Mailing Address - Country:US
Mailing Address - Phone:701-222-1300
Mailing Address - Fax:
Practice Address - Street 1:1100 WEISS AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0539
Practice Address - Country:US
Practice Address - Phone:701-222-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26704261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1225057417OtherPERSONAL NPI