Healthcare Provider Details

I. General information

NPI: 1780383331
Provider Name (Legal Business Name): NIAM LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2023
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 1ST AVE S
FARGO ND
58103-1747
US

IV. Provider business mailing address

1206 1ST AVE S
FARGO ND
58103-1747
US

V. Phone/Fax

Practice location:
  • Phone: 701-929-1996
  • Fax:
Mailing address:
  • Phone: 701-929-1996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WAYNE ALLEN BARTZ
Title or Position: COO
Credential:
Phone: 701-929-1996