North Dakota Med Spa Regulations
North Dakota has no med-spa-specific statute or facility license; cosmetic medicine runs on the general Medical Practice Act (NDCC 43-17), Board of Nursing aesthetic/IV practice guidance (prescriber good-faith exam plus prescriber-ordered nurse administration), and a 2026 Board of Cosmetology advanced-esthetics framework (NDCC 43-11 / NDAC Title 32) that lets licensed advanced estheticians do microneedling, chemical peels, and nonablative laser only under an MD/PA/APRN collaborative agreement.
Last reviewed: 2026-07-21
Who can inject Botox and dermal fillers in North Dakota?
Injecting FDA-approved aesthetic agents (e.g., botox, dermal fillers) requires prescriptive authority to order it and licensed-nurse competency to administer it: the prescriber must be a physician (MD/DO), physician assistant, or APRN with prescriptive authority, and an RN with comprehensive accredited aesthetics training may inject only under that prescriber's specific order. LPNs are outside this guidance and cosmetologists/estheticians are expressly prohibited from injections and dermal fillers.
Source: ND Board of Nursing, Practice Guidance: Role of the Nurse in Aesthetic Practices in Retail Settings (rev. 1/2026) — RN may inject FDA-approved agents only under a prescriber order; prescriber must be Physician, PA, or APRN with prescriptive authority; RN cannot prescribe/dispense, ND Board of Nursing, Nursing Practice FAQ — RN with training may inject FDA-approved aesthetic agents; prescriber must be MD/PA/APRN, ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — injections and dermal fillers are outside the cosmetology/esthetics scope (NDCC 43-11-01(1))
Does North Dakota require a good-faith exam before treatment?
Before any aesthetic treatment, the prescriber must establish a prescriber-client relationship by performing and documenting an initial history and physical assessment and developing a client-specific plan; a general 'medical clearance' does not satisfy this, and any change to the plan or order requires a new documented H&P first. Telehealth is acceptable for the prescriber's assessment (NDCC 26.1-36-09.15(1)(g)), but photographs of a client do not constitute telehealth and are not acceptable for the assessment.
Source: ND Board of Nursing, Role of the Nurse in Aesthetic Practices (rev. 1/2026) — prescriber must perform initial documented H&P and client-specific plan before treatment; changes require new H&P; telehealth per NDCC 26.1-36-09.15(1)(g) (NDAC 54-05-03.1-03.2), ND Board of Nursing, Nursing Practice FAQ — 'Photos of a client do not constitute telehealth and are not considered appropriate for a client assessment'; telehealth otherwise acceptable
Does a med spa in North Dakota need a medical director?
North Dakota does not license med spas or clinics and imposes no titled 'medical director' requirement, but it does require a supervising or collaborating prescriber for the medical work: nurse-delivered injectables and IV therapy must run under a physician/PA/APRN prescriber, and advanced estheticians performing microneedling, deeper chemical peels, or nonablative laser must have a written collaborative agreement with a supervising MD, PA, or APRN filed with the Board of Cosmetology (onsite at least four hours per week and reachable within 30 minutes). The oversight provider need not be a physician (PA/APRN qualify), so this functions as a mandatory medical-oversight relationship rather than a physician-only medical directorship.
Source: ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — collaborative agreement with supervising MD/PA/APRN required (NDAC 32-05-01-08); supervisor onsite min 4 hrs/week, reachable within 30 min, max 5 establishments, ND Board of Nursing, Role of the Nurse in Aesthetic Practices (rev. 1/2026) — a prescriber (Physician, PA, or APRN) order and ongoing prescriber involvement required; Board 'does not have jurisdiction over independent clinics or retail settings', ND Board of Nursing, Retail IV Therapy Guidance (approved 12/13/2024) — 'North Dakota does not license clinics; the prescriber(s) must be the responsible party'
Can a non-physician own a med spa in North Dakota?
North Dakota follows the corporate-practice-of-medicine doctrine: a professional corporation, PLLC, or PLLP rendering a licensed service may have as owners only individuals licensed to render that same professional service (NDCC 10-31-01(7)-(9)), and medicine is not among the professions the statute authorizes to have non-licensed 'minority' owners (NDCC 10-31-04(3), limited to accountancy and architecture/engineering). Separately, only a licensed hospital, nonprofit entity, or charitable trust may employ a physician to practice medicine while preserving the physician's independent judgment (NDCC 43-17-42), and fee-splitting/kickbacks are grounds for discipline (NDCC 43-17-31(1)(r)) — so a lay-owned for-profit corporation cannot own a medical practice, though a PA or APRN may own an entity rendering their own scope of service.
Source: NDCC Ch. 10-31 Professional Organizations — professional corporation/LLC/LLP shareholders/members must be individuals licensed to render the same professional service (10-31-01(7)-(9)); non-licensed minority owners authorized only for ch. 43-02.2 and 43-03 (10-31-04(3)), NDCC 43-17-42 — only a licensed hospital, nonprofit entity, or charitable trust may employ a physician, and only if the employment does not affect the physician's independent judgment; such employer 'is not engaged in the practice of medicine'
What supervision does North Dakota require for med-spa procedures?
For nurse-delivered aesthetics/IV, the prescriber (MD/DO/PA/APRN) must issue a client-specific order, stay involved through the treatment plan, and be able to respond immediately to complications; direct vs. indirect supervision is defined in NDAC 54-01-03-01(78), and a PA may supervise, delegate, and assign therapeutic/diagnostic measures to licensed or unlicensed personnel (NDCC 43-17-02.1). For advanced estheticians, the supervising MD/PA/APRN must approve written protocols for each procedure, be onsite a minimum of four hours per week, be reachable by telecommunication within 30 minutes during procedure hours, and may cover no more than five establishments (NDAC 32-05-01-08).
Source: ND Board of Nursing, Role of the Nurse in Aesthetic Practices (rev. 1/2026) — supervision definitions (direct/indirect, NDAC 54-01-03-01(78)); supervising professional must respond immediately to complications; prescriber order required before RN provides services, ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — supervising-provider responsibilities: onsite min 4 hrs/week, 30-min availability, protocol approval, max 5 establishments (NDAC 32-05-01-08(d)(7),(i)), NDCC 43-17-02.1(2)(c) — physician assistant may supervise, delegate, and assign therapeutic and diagnostic measures to licensed or unlicensed personnel
What can an esthetician legally do in North Dakota?
Basic esthetics (NDCC 43-11-01(5)) is limited to noninvasive skin care — microdermabrasion, dermaplaning, high frequency, low-concentration cosmetic peels (<30% AHA / <20% BHA / <15% resorcinol / <15% TCA), waxing, and lash/brow work — and a cosmetologist, manicurist, or esthetician 'may not alter, cut, puncture, or damage any living cells whether superficially or through the use of laser, light, or energy' (NDCC 43-11-27.2(1)). Effective January 1, 2026, a separate Advanced Esthetician license (NDCC 43-11-01(3), NDAC Title 32) authorizes microneedling, advanced/combination chemical peels, extractions with lancets, and nonablative energy procedures with Board-approved certification and, for the deeper procedures, a collaborative agreement/supervision by an MD/PA/APRN. Injections, dermal fillers, blood draws, ablative procedures, and any procedure below the stratum corneum remain outside all cosmetology scopes.
Source: NDCC Ch. 43-11 (Cosmetologists) — §43-11-27.2 Scope of practice: noninvasive care limitation with advanced-esthetic exception; §43-11-01 definitions of esthetics and advanced esthetics, ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — esthetics scope NDCC 43-11-01(5); advanced esthetics NDCC 43-11-01(3); noninvasive limitation NDCC 43-11-27.2(1); prohibited procedures NDCC 43-11-01(1); NDAC Title 32 eff. 1/1/2026
Who can operate a cosmetic laser in North Dakota?
Ablative laser procedures (that excise, vaporize, disintegrate, or remove living tissue) are the practice of medicine and are limited to physicians and delegated mid-levels; basic estheticians and cosmetologists may never use laser, light, or energy on living cells (NDCC 43-11-27.2(1)). Nonablative cosmetic laser/IPL/RF may be performed directly by physicians (MD/DO), PAs, and APRNs; by RNs under a prescriber order (nurse guidance treats selecting the device/setting as prescribing, which is outside RN scope); and by licensed advanced estheticians under a collaborative agreement with a supervising MD/PA/APRN, with a written ANSI Z136.3 laser-safety program, a designated Laser Safety Officer, and FDA-cleared devices (NDAC 32-05-01-08(d)(8), 32-03-01-10.2(3)).
Source: NDCC 43-11-27.2(1) — cosmetologist/esthetician may not alter, cut, puncture, or damage living cells through laser, light, or energy, ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — advanced estheticians may perform nonablative laser/IPL/RF under collaborative agreement (NDAC 32-05-01-08); required laser-safety program (ANSI Z136.3) and Laser Safety Officer (NDAC 32-05-01-08(d)(8), 32-03-01-10.2(3)); ablative procedures prohibited, ND Board of Nursing, Role of the Nurse in Aesthetic Practices (rev. 1/2026) — RN may not select a device or device setting (element of prescribing); services provided only under prescriber order (NDAC 54-05-03.1-10)
What are the rules for IV therapy and vitamin drips in North Dakota?
In retail/med-spa/IV-hydration settings, IV therapy may be administered by an RN or an IV-certified LPN, but only under a valid order from a prescriber (physician, PA, or APRN with prescriptive authority) who has first performed and documented an initial history and physical and developed a client-specific plan; telehealth is acceptable for that assessment. Standing orders or protocols are not valid prescriptions without a prescriber-client relationship, and the RN/LPN may not select the medication/solution, dosage, device, or device setting, nor independently purchase drugs or equipment (NDAC 54-05-03.1-10; 54-05-03.1-03.2).
Does a med spa have to register or hold a license in North Dakota?
North Dakota does not license or register medical spas or medical clinics as facilities — the Board of Nursing states it has no jurisdiction over independent clinics/retail settings and that 'North Dakota does not license clinics,' so the prescriber is the responsible party for legend-drug receipt and storage. A location offering cosmetology or esthetic services, however, must hold a cosmetology establishment license from the ND Board of Cosmetology, advanced-esthetic procedure rooms carry specific facility requirements (NDAC 32-03-01-10.2), and any advanced-esthetics collaborative agreement and written protocols must be filed with that Board before supervised procedures begin.
Source: ND Board of Nursing, Role of the Nurse in Aesthetic Practices (rev. 1/2026) — Board 'does not have jurisdiction or oversight over independent clinics or retail settings'; 'North Dakota does not license clinics', ND State Board of Cosmetology, Advanced Esthetic Procedures Handbook (2026) — establishment license required (NDAC 32-03-01); advanced-procedure facility requirements (NDAC 32-03-01-10.2); collaborative agreement/protocols filed with Board (NDAC 32-05-01-08)
What are the penalties for practicing outside scope in North Dakota?
Practicing medicine without a license, or otherwise violating the Medical Practice Act where no other penalty is specified, is a class B misdemeanor, and the state may also seek a civil injunction without proof of actual damages (NDCC 43-17-34). The Board of Medicine may discipline licensees (including for aiding or abetting unlicensed practice and for fee-splitting) under NDCC 43-17-31, assess prosecution costs (43-17-31.1), and impose an ex parte temporary suspension when continued practice poses significant risk of serious harm (43-17-32.1); the Boards of Nursing and Cosmetology hold parallel disciplinary authority over their licensees under NDCC 43-12.1 and 43-11.
Source: NDCC 43-17-34 — practicing medicine without a license, and unspecified violations of ch. 43-17, are a class B misdemeanor; civil injunction available without proof of damages, NDCC 43-17-31 / 43-17-31.1 / 43-17-32.1 — grounds for disciplinary action (incl. 43-17-31(1)(h) aiding/abetting unlicensed practice; (r) fee-splitting), costs of prosecution, and ex parte temporary suspension
Cite this page
Build a compliant med spa faster
Board-ready SOPs and compliance checklists mapped to these requirements.
SOP kits by topic: Injectables · Skin & Laser · Operations & Compliance · Body & Wellness · Weight Loss · Hormone Therapy · Emergency Protocols
This information is provided for general educational purposes only and is not legal advice. Regulations change — verify current requirements with your state medical/nursing board before acting.