Healthcare Provider Details

I. General information

NPI: 1902633290
Provider Name (Legal Business Name): DENNIS GICHANA SRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2024
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 36TH ST S UNIT 2
FARGO ND
58103-6290
US

IV. Provider business mailing address

3020 36TH ST S UNIT 2
FARGO ND
58103-6290
US

V. Phone/Fax

Practice location:
  • Phone: 701-955-3410
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR47786
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: