Healthcare Provider Details

I. General information

NPI: 1730015793
Provider Name (Legal Business Name): FNU BRANDY FAVOUR WESUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BELMONT RD APT 203
GRAND FORKS ND
58201-4983
US

IV. Provider business mailing address

401 BELMONT RD APT 203
GRAND FORKS ND
58201-4983
US

V. Phone/Fax

Practice location:
  • Phone: 218-791-3908
  • Fax:
Mailing address:
  • Phone: 218-791-3908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: