Healthcare Provider Details

I. General information

NPI: 1891496089
Provider Name (Legal Business Name): KARA LEE A MEDUNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 I94 BUSINESS LOOP E
DICKINSON ND
58601-6434
US

IV. Provider business mailing address

1463 I94 BUSINESS LOOP E
DICKINSON ND
58601-6434
US

V. Phone/Fax

Practice location:
  • Phone: 701-227-7500
  • Fax: 701-227-7575
Mailing address:
  • Phone: 701-227-7500
  • Fax: 701-227-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: