Basic Information
| Provider Information | |||||||||
| NPI: | 1487690616 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIDDER | ||||||||
| FirstName: | ANNE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013645751 | ||||||||
| FaxNumber: | 7013645750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 04/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 7428 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10706 | 05 | ND | MEDICAID | 58D29KI | 01 | ND | MNBS-NP # | OTHER | 15999 | 01 | ND | NDBS FGO # | OTHER | 0108117 | 01 | ND | MEDICA-FGO # | OTHER | 031018200 | 05 | ND | MEDICAID | 0108117 | 01 | ND | MEDICA-INN # | OTHER | 0117889 | 01 | ND | MEDICA NP # | OTHER | 58D27KI | 01 | ND | MNBS-FGO # | OTHER | DA9011026974 | 01 | ND | PREF 1 # | OTHER | HP38246 | 01 | ND | HEALTHPARTNERS # | OTHER | 822783 | 01 | ND | ARAZ # | OTHER |