Healthcare Provider Details

I. General information

NPI: 1578302832
Provider Name (Legal Business Name): FORSTILIAL ABBAH DWEH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2024
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 31ST AVE W APT 317A
WILLISTON ND
58801-6964
US

IV. Provider business mailing address

3009 31ST AVE W APT 317A
WILLISTON ND
58801-6964
US

V. Phone/Fax

Practice location:
  • Phone: 314-249-2007
  • Fax:
Mailing address:
  • Phone: 314-249-2007
  • 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: