Healthcare Provider Details

I. General information

NPI: 1467435370
Provider Name (Legal Business Name): LAUREL DONELDA GRAMS-REMINGTON LICSW, MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MISSLE AVE
MINOT AFB ND
58705-5003
US

IV. Provider business mailing address

3690 72ND ST SE
MINOT ND
58701-8048
US

V. Phone/Fax

Practice location:
  • Phone: 701-723-5527
  • Fax:
Mailing address:
  • Phone: 701-839-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3438
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: