Healthcare Provider Details

I. General information

NPI: 1487984712
Provider Name (Legal Business Name): ELIAS DONALD THIENPONT RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 3RD AVE W PO BOX A
RICHARDTON ND
58652-7100
US

IV. Provider business mailing address

418 3RD AVE W PO BOX A
RICHARDTON ND
58652-7100
US

V. Phone/Fax

Practice location:
  • Phone: 701-974-3315
  • Fax: 701-974-3317
Mailing address:
  • Phone: 701-974-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR25022
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: