Healthcare Provider Details

I. General information

NPI: 1306759907
Provider Name (Legal Business Name): ASHLEY MARIE GOURNEAU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9889 BIA ROAD 1
ROLLA ND
58367-9402
US

IV. Provider business mailing address

PO BOX 713
BELCOURT ND
58316-0713
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-8037
  • Fax:
Mailing address:
  • Phone: 701-550-6072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: