Healthcare Provider Details

I. General information

NPI: 1780349738
Provider Name (Legal Business Name): TENIN ANGE BOHUI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2426 9TH ST S
FARGO ND
58103-5758
US

IV. Provider business mailing address

1010 2ND AVE S
FARGO ND
58103-8226
US

V. Phone/Fax

Practice location:
  • Phone: 701-298-4500
  • Fax:
Mailing address:
  • Phone: 701-239-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1568-7-15-26A
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: