MS. GILLIAN AMANDA GERVAIS FREEBORN (NPI# 1780025932) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780025932 |
| Entity Type | Individual |
| Full Name | MS. GILLIAN AMANDA GERVAIS FREEBORN |
| Practice Address |
2102 Elm Street N Fargo ND 58102-2498 |
| Mailing Address |
18 4th St S Apt 202 Moorhead MN 56560-2660 |
| Practice Telephone | 7012393700 |
| Mailing Telephone | 7015266870 |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2013-07-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
2102 ELM STREET N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-2498 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1396203709 | Victoria Ann Davis | Student in an Organized Health Care Education/Training Program | 1340 Administration Avenue, Fargo, ND 58105 | 2019-03-05 |
| 1598229585 | Natalie Jean Steblay | Student in an Organized Health Care Education/Training Program | 1638 9th St N, Fargo, ND 58102-2210 | 2019-01-24 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1639600174 | David Parker | Student in an Organized Health Care Education/Training Program | 408 Roberts St N Apt 214, Fargo, ND 58102-4622 | 2017-03-26 |
| 1942731807 | Heather Liebe | Student in an Organized Health Care Education/Training Program | 3807 30th Ave S Apt 208, Fargo, ND 58104-7750 | 2017-03-22 |
| 1063866796 | Jerrod Tyler Heermans | Student in an Organized Health Care Education/Training Program | 3528 30th Ave S, Fargo, ND 58103-6239 | 2016-04-19 |
| 1871839803 | Nicholas O'rourke | Student in an Organized Health Care Education/Training Program | 2526 9th St S, Fargo, ND 58103-5708 | 2012-12-19 |
| 1881952778 | Michael A Wolfe | Student in an Organized Health Care Education/Training Program | 3113 26th Ave S, Fargo, ND 58103-5079 | 2012-04-27 |
| 1891920542 | Walter Vincent Samuel | Student in an Organized Health Care Education/Training Program | 2605 64th Ave S, Fargo, ND 58104-7403 | 2009-05-26 |
| Find all providers in FARGO | ||||
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| 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.