Healthcare Provider Details

I. General information

NPI: 1457738254
Provider Name (Legal Business Name): SHAWNA A DANDURAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAWNA A HALL MSW

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 13TH AVE S
FARGO ND
58103-3602
US

IV. Provider business mailing address

PO BOX 2168
FARGO ND
58107-2168
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-3620
  • Fax: 701-234-3515
Mailing address:
  • Phone: 701-234-2119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5110
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: