Healthcare Provider Details

I. General information

NPI: 1457244352
Provider Name (Legal Business Name): RITA JEAN WELTIKOL CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

IV. Provider business mailing address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-8500
  • Fax:
Mailing address:
  • Phone: 701-857-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7052
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: