Basic Information
| Provider Information | |||||||||
| NPI: | 1598413312 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REXINE | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | JILL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 S 2ND ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585045729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015164637 | ||||||||
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| Practice Location | |||||||||
| Address1: | 521 10TH AVE N | ||||||||
| Address2: | |||||||||
| City: | CASSELTON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580123442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012208273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2022 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R31653 | ND | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | 363L00000X | R31653 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.