Healthcare Provider Details

I. General information

NPI: 1447161013
Provider Name (Legal Business Name): WILLARD ARTHUR EDWARDS III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1294
TIOGA ND
58852-1294
US

IV. Provider business mailing address

6559 HIGHWAY 40
TIOGA ND
58852
US

V. Phone/Fax

Practice location:
  • Phone: 701-648-9358
  • Fax:
Mailing address:
  • Phone: 701-648-9358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: