Healthcare Provider Details

I. General information

NPI: 1710815592
Provider Name (Legal Business Name): WISLANDE JOSEPH CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 41ST ST S
FARGO ND
58104-4547
US

IV. Provider business mailing address

3401 41ST ST S
FARGO ND
58104-4547
US

V. Phone/Fax

Practice location:
  • Phone: 701-729-2200
  • Fax:
Mailing address:
  • Phone: 701-729-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number84681
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: