Healthcare Provider Details

I. General information

NPI: 1376202416
Provider Name (Legal Business Name): GWENDOLYN M HOULE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 SW 2ND ST LOT 38
DUNSEITH ND
58329
US

IV. Provider business mailing address

PO BOX 926
DUNSEITH ND
58329-0926
US

V. Phone/Fax

Practice location:
  • Phone: 605-214-2886
  • Fax:
Mailing address:
  • Phone: 605-214-2886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: