Healthcare Provider Details

I. General information

NPI: 1669399853
Provider Name (Legal Business Name): GREYSEN ULMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 116G AVE SE
ROGERS ND
58479-9661
US

IV. Provider business mailing address

2122 116G AVE SE
ROGERS ND
58479-9661
US

V. Phone/Fax

Practice location:
  • Phone: 701-450-4562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: