Healthcare Provider Details

I. General information

NPI: 1518177302
Provider Name (Legal Business Name): ANTHONY ALLEN AGARD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 NORTH RIVER ROAD
FORT YATES ND
58538
US

IV. Provider business mailing address

PO BOX J
FORT YATES ND
58538-0527
US

V. Phone/Fax

Practice location:
  • Phone: 701-854-3831
  • Fax:
Mailing address:
  • Phone: 701-854-3831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR23919
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: