Provider Demographics
NPI:1972862332
Name:ULBRICHT, AMY E (NP-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:E
Last Name:ULBRICHT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5759
Mailing Address - Country:US
Mailing Address - Phone:701-365-8670
Mailing Address - Fax:701-365-8701
Practice Address - Street 1:1800 21ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5759
Practice Address - Country:US
Practice Address - Phone:701-365-8670
Practice Address - Fax:701-365-8701
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX741500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741500OtherLIC NUMBER