Healthcare Provider Details

I. General information

NPI: 1043890080
Provider Name (Legal Business Name): LINDSEY ANN WRETLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S 4TH ST STE 401
GRAND FORKS ND
58201-4715
US

IV. Provider business mailing address

930 N 3RD ST
GRAND FORKS ND
58203-2408
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: