Facts
- Status
- A
- Credential
- NP
- Type
- Individual
- Enumeration date
- 2006-07-12
- Last updated
- 2012-05-23
Licenses
- License MN
- R1561072
- License ND
- R27650
Location
- Practice location
- 1200 ROBERTS AVE NE, COOPERSTOWN MEDICAL CENTER
- City
- COOPERSTOWN ND
- Postal code
- 584257101
- Phone
- 701-797-2128
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
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.