Healthcare Provider Details

I. General information

NPI: 1811041270
Provider Name (Legal Business Name): WINMAR DIAGNOSTICS NORTH CENTRAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 12TH AVE S STE B
FARGO ND
58103-8723
US

IV. Provider business mailing address

2700 12TH AVE S STE B
FARGO ND
58103-8723
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-7424
  • Fax: 701-239-4792
Mailing address:
  • Phone: 701-235-7424
  • Fax: 701-239-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARCIA ANN NELSON
Title or Position: CEO
Credential:
Phone: 701-235-7424