CANOPY MEDICAL CLINIC, PLLC (NPI# 1386280261) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386280261 |
| Entity Type | Organization |
| Organization Name | CANOPY MEDICAL CLINIC, PLLC |
| Practice Address |
100 4th St S Fargo ND 58103-1929 |
| Mailing Address |
100 4th St S Ste 608 Fargo ND 58103-1940 |
| Practice Telephone | 7013060943 |
| Mailing Telephone | 7012645200 |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2020-01-31 |
| Authorized Official Name | HEIDI SELZLER-ECHOLA (MEDICAL DIRECTOR/OWNER) |
| Authorized Official Telephone | 7012645200 |
| Authorized Official Credential | APRN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
100 4TH ST S |
| City | FARGO |
| State | ND |
| Zip Code | 58103-1929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720078405 | Mark Allan Schaffer | Dentist | 100 4th St S, Suite 312, Fargo, ND 58103-1929 | 2005-10-25 |
| 1437715166 | Diana Rose Slivensky | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2019-05-17 |
| 1861945784 | Resolve Behavioral Health, LLC | Community/Behavioral Health | 100 4th St S, Fargo, ND 58103-1929 | 2016-07-27 |
| 1578927315 | Jason Cossette | Pharmacist | 100 4th St S, Fargo, ND 58103-1929 | 2016-04-07 |
| 1437521366 | Nicole A Kiewel | Clinical Neuropsychologist | 100 4th St S, Fargo, ND 58103-1929 | 2015-10-30 |
| 1821472143 | Angela M Lee | Nurse Practitioner | 100 4th St S, Fargo, ND 58103-1929 | 2015-07-16 |
| 1104231992 | Mustafa Abdulhusein | Psychiatry & Neurology | 100 4th St S, Fargo, ND 58103 | 2014-06-30 |
| 1609205988 | Robyn Maley | Psychologist | 100 4th St S, Fargo, ND 58103-1929 | 2013-11-06 |
| 1699102897 | Lindsey Marie Sloan Peterson | Nurse Practitioner | 100 4th St S, Fargo, ND 58103-1929 | 2013-10-02 |
| 1609116037 | Monica R Schneider | Social Worker | 100 4th St S, Fargo, ND 58103-1929 | 2013-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659924843 | Amanda Hericks | Dentist | 1338 Gateway Drive S, Fargo, ND 58103 | 2019-07-17 |
| 1285298240 | Ann Louise Breen | Optometrist | Sanford Southpointe Eye Center & Optical, 2400 32nd Ave. S., Fargo, ND 58103 | 2019-04-25 |
| 1245706597 | Lisa Elaine Livingston | Counselor | 1337 14 and Half St. S., Fargo, ND 58103 | 2018-10-15 |
| 1528569662 | Misty Lynn Hagen | Counselor | 901 28th St. South, Suite B, Fargo, ND 58103 | 2018-02-23 |
| 1083133011 | Faith Homecare Professionals LLC | Home Health | 304 25th St S, Suite B, Fargo, ND 58103 | 2017-09-11 |
| 1982138749 | Matthew Troyer | Pharmacist | 2425 13th Ave, Fargo, ND 58103 | 2017-04-18 |
| 1801338504 | Amy Nguyen Christianson | Chiropractor | 1650 45th St S Ste 113, Fargo, ND 58103 | 2016-11-11 |
| 1245772359 | Andrea Marie Hanson | Nurse Practitioner | 2400 32nd Ave South, Fargo, ND 58103 | 2016-11-07 |
| 1831647940 | Abigail Carmen Burkett Vetter | Nurse Practitioner | 2928 University Dr S Suite 101, Fargo, ND 58103 | 2016-09-18 |
| 1013361302 | Nancy Knowlton | Speech-Language Pathologist | 3001 11th Ave S, Beyond Boundaries Speech-language, Fargo, ND 58103 | 2016-04-22 |
| Find all providers in zip 58103 | ||||
| Taxonomy Code | 363LW0102X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Women's Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598772345 | Renai D Ehrichs | Nurse Practitioner | 2101 Elm Street, Fargo, ND 58102 | 2006-08-02 |
| 1629533724 | Alexa Marie Volesky | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103 | 2019-02-04 |
| 1891265757 | Carissa Abigail Monique Lawrence | Nurse Practitioner | 5225 23rd Ave S, Fargo, ND 58104-7927 | 2018-12-04 |
| 1730535386 | Ashley A Ruesink | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2016-05-12 |
| 1063822062 | Amanda Swanson | Nurse Practitioner | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2014-04-30 |
| 1679868087 | Sandra Kay Alberty | Nurse Practitioner | 512 1st Ave N, Fargo, ND 58102-4804 | 2011-06-14 |
| 1750466801 | Audrey Eckes | Nurse Practitioner | 1240 25th St S, Fargo, ND 58103-2367 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720691645 | Crystal Lynn Lesmeister | Nurse Practitioner | 110 W Broadway Ste 101, Williston, ND 58801-6056 | 2020-08-29 |
| 1255448668 | Cheryl A. Hefta | Nurse Practitioner | 416 2nd Ave N, Fort Totten, ND 58335 | 2006-08-23 |
| 1619939006 | Carol Sue Moen | Nurse Practitioner | 524 4th Ave Ne, Unit 9, Devils Lake, ND 58301-2490 | 2006-04-03 |
| 1154319911 | Gail Rae Halverson | Nurse Practitioner | 360 Division Ave, Suite 200, Grand Forks, ND 58201-4702 | 2005-10-06 |
| 1700420288 | Heather Rose Hass | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2019-10-29 |
| 1619281987 | Heidi Lynn Grondahl | Nurse Practitioner | 1301 15th Ave W, Williston, ND 58801-3821 | 2010-07-29 |
| 1801007844 | Cindy M Anderson | Nurse Practitioner | 1551 28th Ave S, Grand Forks, ND 58201-6782 | 2007-05-24 |
| 1619054327 | Laura Joy Spicer | Nurse Practitioner | 1000 South Columbia Road, Grand Forks, ND 58206-6002 | 2006-11-01 |
| 1578654372 | Cora-len Hutton | Nurse Practitioner | 1000 S Columbia Rd, Grand Forks, ND 58201-4032 | 2006-09-27 |
| 1861432338 | Joelle R Thomas | Nurse Practitioner | 122 2nd St Nw, Jamestown, ND 58401-3117 | 2006-06-06 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on CANOPY MEDICAL CLINIC, PLLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.