Healthcare Provider Details

I. General information

NPI: 1992189260
Provider Name (Legal Business Name): CHUANSHEN WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 S COLUMBIA RD
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-780-6697
  • Fax: 718-240-5451
Mailing address:
  • Phone: 701-780-1891
  • Fax: 718-240-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPT15654
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: