Healthcare Provider Details

I. General information

NPI: 1750679080
Provider Name (Legal Business Name): AL-MARIE GRACE TINGSON LOGRONO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 11/17/2022
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 7TH ST NE - ALTRU CLINIC/DEVILS LAKE
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2157
  • Fax: 810-342-5810
Mailing address:
  • Phone: 701-780-1891
  • Fax: 810-342-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number13139
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: