Healthcare Provider Details

I. General information

NPI: 1619814324
Provider Name (Legal Business Name): MEGAN WOLTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4522 BLUESTEM CT S UNIT B
FARGO ND
58104-4303
US

IV. Provider business mailing address

804 UNITED DR
HORACE ND
58047-5517
US

V. Phone/Fax

Practice location:
  • Phone: 701-200-6361
  • Fax:
Mailing address:
  • Phone: 701-200-6361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: