Healthcare Provider Details

I. General information

NPI: 1063236909
Provider Name (Legal Business Name): DWAYNE LEWIS FRELOT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 10TH ST W
WEST FARGO ND
58078-8890
US

IV. Provider business mailing address

5224 10TH ST W
WEST FARGO ND
58078-8890
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-8093
  • Fax:
Mailing address:
  • Phone: 701-388-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: