Healthcare Provider Details

I. General information

NPI: 1962365569
Provider Name (Legal Business Name): MS. TELPEH G WESSEH I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 36TH AVE S APT 205
FARGO ND
58104-5167
US

IV. Provider business mailing address

2644 36TH AVE S APT 205
FARGO ND
58104-5167
US

V. Phone/Fax

Practice location:
  • Phone: 701-831-4735
  • Fax:
Mailing address:
  • Phone: 701-831-4735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number00000001234455
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: