Healthcare Provider Details

I. General information

NPI: 1750210563
Provider Name (Legal Business Name): MR. ZACHARY G IDLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. ZACHARY G IDLAND- SEMANKO

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 COUNTY RD. 81 N.
FARGO ND
58102
US

IV. Provider business mailing address

2631 12TH AVE S STE D
FARGO ND
58103-8741
US

V. Phone/Fax

Practice location:
  • Phone: 701-238-7808
  • Fax:
Mailing address:
  • Phone: 701-515-9338
  • 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: