Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2024-08-27
- Last updated
- 2024-08-27
Specialties
Licenses
- License ND
- 356
Location
- Practice location
- 12272 106TH ST NE
- City
- WALHALLA ND
- Postal code
- 582829519
- Phone
- 701-521-5122
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.