Basic Information
| Provider Information | |||||||||
| NPI: | 1932126414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PFENNIG | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Practice Location | |||||||||
| Address1: | 520 CHAUTAUQUA BLVD | ||||||||
| Address2: | |||||||||
| City: | VALLEY CITY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580723145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018456000 | ||||||||
| FaxNumber: | 7018456150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 03/30/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R28569 | ND | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | R28569 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.