Healthcare Provider Details

I. General information

NPI: 1578485710
Provider Name (Legal Business Name): MR. ROGER TAMBE ENOW TAMBE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 9TH AVENUE CIR S APT 103
FARGO ND
58103-7048
US

IV. Provider business mailing address

4251 9TH AVENUE CIR S APT 103
FARGO ND
58103-7048
US

V. Phone/Fax

Practice location:
  • Phone: 701-809-4223
  • Fax:
Mailing address:
  • Phone: 701-809-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: