Provider Demographics
NPI:1245824838
Name:PURSIFULL, ROBIN (FNP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:PURSIFULL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 16TH ST SW APT 316
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6909
Mailing Address - Country:US
Mailing Address - Phone:850-543-9469
Mailing Address - Fax:
Practice Address - Street 1:1705 4TH AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-2912
Practice Address - Country:US
Practice Address - Phone:701-839-0474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDF02210877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily