Healthcare Provider Details

I. General information

NPI: 1265013858
Provider Name (Legal Business Name): KENDALL WILLIAM BJERKE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 7TH ST NW
VALLEY CITY ND
58072-2530
US

IV. Provider business mailing address

326 7TH ST NW
VALLEY CITY ND
58072-2530
US

V. Phone/Fax

Practice location:
  • Phone: 701-840-2743
  • Fax:
Mailing address:
  • Phone: 701-840-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: