1831943265 NPI number — ANGELA MARIE ENSRUD SOLE PROPRIETOR

Table of content: ANGELA MARIE ENSRUD SOLE PROPRIETOR (NPI 1831943265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831943265 NPI number — ANGELA MARIE ENSRUD SOLE PROPRIETOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENSRUD
Provider First Name:
ANGELA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
SOLE PROPRIETOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERA
Provider Other First Name:
ANGELA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HOME HEALTH
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831943265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1340 13TH AVE S APT 5
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARGO
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58103-3946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-371-2966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1340 13TH AVE S APT 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-3946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-371-2966
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2024

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: 3747P1801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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