Healthcare Provider Details

I. General information

NPI: 1306787551
Provider Name (Legal Business Name): MRS. LARETTA DENISE SUAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LARETTA DENISE ADAMS

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 9 1/2 ST N APT 101
FARGO ND
58102-1354
US

IV. Provider business mailing address

3024 9 1/2 ST N APT 101
FARGO ND
58102-1354
US

V. Phone/Fax

Practice location:
  • Phone: 701-831-4113
  • Fax:
Mailing address:
  • Phone: 701-831-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number78914
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: