Healthcare Provider Details

I. General information

NPI: 1710608120
Provider Name (Legal Business Name): MRS. CARLA ERNESTINA BJORNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 10TH ST NW
DEVILS LAKE ND
58301-1747
US

IV. Provider business mailing address

610 10TH ST NW
DEVILS LAKE ND
58301-1747
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-3177
  • Fax:
Mailing address:
  • Phone: 701-665-3177
  • Fax:

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: