Facts
- Status
- A
- Credential
- CNS
- Type
- Individual
- Enumeration date
- 2006-07-22
- Last updated
- 2012-11-14
Specialties
Licenses
- License ND
- R13529
Location
- Practice location
- 801 BROADWAY N
- City
- FARGO ND
- Postal code
- 581023641
- Phone
- 701-234-5015
Medicare
- PECOS
- No PECOS enrollment row matched 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.