Healthcare Provider Details

I. General information

NPI: 1922934223
Provider Name (Legal Business Name): MR. DUANE ALLEN WUOLLET
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 5TH AVE
CANDO ND
58324-6117
US

IV. Provider business mailing address

930 5TH AVE
CANDO ND
58324-6117
US

V. Phone/Fax

Practice location:
  • Phone: 218-526-0650
  • Fax:
Mailing address:
  • Phone: 218-526-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: