Provider Demographics
NPI:1285373738
Name:UGELSTAD, THOMAS (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:UGELSTAD
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 AMBER VALLEY PKWY S STE 102
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4594
Mailing Address - Country:US
Mailing Address - Phone:701-251-0551
Mailing Address - Fax:
Practice Address - Street 1:4656 AMBER VALLEY PKWY S STE 102
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-4594
Practice Address - Country:US
Practice Address - Phone:701-251-0551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR46309363LP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse