Healthcare Provider Details

I. General information

NPI: 1881550937
Provider Name (Legal Business Name): JOELYN FOUNTAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2026
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 4TH AVE SE
DEVILS LAKE ND
58301-3910
US

IV. Provider business mailing address

1203 4TH AVE SE
DEVILS LAKE ND
58301-3910
US

V. Phone/Fax

Practice location:
  • Phone: 701-270-3102
  • Fax:
Mailing address:
  • Phone: 701-270-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: