1174749501 NPI number — MS. SHERRIE R. LANDSEM WALFORD MT

Table of content: MS. SHERRIE R. LANDSEM WALFORD MT (NPI 1174749501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174749501 NPI number — MS. SHERRIE R. LANDSEM WALFORD MT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANDSEM WALFORD
Provider First Name:
SHERRIE
Provider Middle Name:
R.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174749501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 AVENUE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVILS LAKE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58301-6002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-662-0213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3883 74TH AVENUE NE
Provider Second Line Business Practice Location Address:
BOX 309
Provider Business Practice Location Address City Name:
FORT TOTTEN
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58335-0309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-766-1600
Provider Business Practice Location Address Fax Number:
701-766-1640
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247ZC0005X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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