Healthcare Provider Details

I. General information

NPI: 1588591028
Provider Name (Legal Business Name): MRS. ADRIENNE MATHENY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 2ND AVE NE STE 202
VALLEY CITY ND
58072-3061
US

IV. Provider business mailing address

258 WINTER SHOW RD SE APT 206
VALLEY CITY ND
58072-4050
US

V. Phone/Fax

Practice location:
  • Phone: 701-253-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: