| CASE NUMBER | I-200-24200-207239 |
| CASE STATUS | Certified |
| RECEIVED DATE | 7/18/2024 |
| DECISION DATE | 7/25/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | Nurse Practitioner, Psychiatry |
| SOC CODE | 29-1171.00 |
| SOC TITLE | Nurse Practitioners |
| FULL TIME POSITION | Y |
| BEGIN DATE | 8/1/2024 |
| END DATE | 1/22/2026 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Sanford Medical Center Fargo |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 801 Broadway N |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Fargo |
| EMPLOYER STATE | ND |
| EMPLOYER POSTAL CODE | 58122 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | +17014172000 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 622110 |
| EMPLOYER POC LAST NAME | Maly |
| EMPLOYER POC FIRST NAME | Shelby |
| EMPLOYER POC MIDDLE NAME | Kate |
| EMPLOYER POC JOB TITLE | Corporate Counsel |
| EMPLOYER POC ADDRESS1 | 1305 W. 18th Street |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Sioux Falls |
| EMPLOYER POC STATE | SD |
| EMPLOYER POC POSTAL CODE | 57105 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | +16053126505 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | shelby.maly@sanfordhealth.org |
| AGENT REPRESENTING EMPLOYER | No |
| AGENT ATTORNEY LAST NAME | |
| AGENT ATTORNEY FIRST NAME | |
| AGENT ATTORNEY MIDDLE NAME | |
| AGENT ATTORNEY ADDRESS1 | |
| AGENT ATTORNEY ADDRESS2 | |
| AGENT ATTORNEY CITY | |
| AGENT ATTORNEY STATE | |
| AGENT ATTORNEY POSTAL CODE | |
| AGENT ATTORNEY COUNTRY | |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | |
| LAWFIRM NAME BUSINESS NAME | |
| STATE OF HIGHEST COURT | |
| NAME OF HIGHEST STATE COURT | |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 1705 Anne Street NW |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Bemidji |
| WORKSITE COUNTY | BELTRAMI |
| WORKSITE STATE | MN |
| WORKSITE POSTAL CODE | 56601 |
| WAGE RATE OF PAY FROM | 107,744.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $107,744.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | II |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2024-01-08 |
