Healthcare Provider Details

I. General information

NPI: 1619898830
Provider Name (Legal Business Name): TODD DEARDURFF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 226TH ST SW
DES LACS ND
58733-9431
US

IV. Provider business mailing address

8100 226TH ST SW
DES LACS ND
58733-9431
US

V. Phone/Fax

Practice location:
  • Phone: 701-720-7006
  • Fax: 701-720-6988
Mailing address:
  • Phone: 701-720-7006
  • Fax: 701-720-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: