Facts
- Status
- A
- Credential
- MPT
- Type
- Individual
- Enumeration date
- 2006-03-30
- Last updated
- 2021-12-27
Specialties
Licenses
- License ND
- 1329
Location
- Practice location
- 214 4TH ST NW
- City
- STEELE ND
- Postal code
- 584827329
- Phone
- 701-202-3280
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.