Provider Demographics
NPI:1457017444
Name:CONVENIENT CARE CLINIC, PLLC
Entity type:Organization
Organization Name:CONVENIENT CARE CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-532-1731
Mailing Address - Street 1:505 32ND AVE E STE B
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-8490
Mailing Address - Country:US
Mailing Address - Phone:701-532-1731
Mailing Address - Fax:701-532-1940
Practice Address - Street 1:505 32ND AVE E STE B
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-8490
Practice Address - Country:US
Practice Address - Phone:701-532-1731
Practice Address - Fax:701-532-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-13
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty