Provider Demographics
NPI:1891464269
Name:VICKERMAN, ANASTASIA
Entity Type:Individual
Prefix:MRS
First Name:ANASTASIA
Middle Name:
Last Name:VICKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 23RD AVE NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-0930
Mailing Address - Country:US
Mailing Address - Phone:701-240-5626
Mailing Address - Fax:
Practice Address - Street 1:613 23RD AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0930
Practice Address - Country:US
Practice Address - Phone:701-240-5626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker