Provider Demographics
NPI:1821769159
Name:NORTH STAR FAMILY CLINIC PLLC
Entity Type:Organization
Organization Name:NORTH STAR FAMILY CLINIC PLLC
Other - Org Name:NORTH STAR FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHIN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:701-774-0390
Mailing Address - Street 1:3620 6TH AVE E
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-6360
Mailing Address - Country:US
Mailing Address - Phone:701-774-0390
Mailing Address - Fax:701-774-0391
Practice Address - Street 1:1500 14TH ST W STE 230
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4078
Practice Address - Country:US
Practice Address - Phone:701-774-0390
Practice Address - Fax:701-774-0391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty