Healthcare Provider Details

I. General information

NPI: 1659847572
Provider Name (Legal Business Name): RHONDA PFENNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

IV. Provider business mailing address

1312 HIGHWAY 49 N
BEULAH ND
58523-6038
US

V. Phone/Fax

Practice location:
  • Phone: 701-873-4445
  • Fax: 701-873-4199
Mailing address:
  • Phone: 701-873-4445
  • Fax: 701-873-4199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21800659
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: