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General NPI Number Information
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NPI Number | 1568574036
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Entity Type | Organization
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Legal Business Name | TRENTON INDIAN SERVICE AREA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 331 4TH AVE E
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City | TRENTON
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State | ND
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Zip | 58853-9998
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Country | US
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Telephone | 701-774-0461
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Fax | 701-774-0461
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Provider Business Mailing Address
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Address Line | 331 4TH AVE E
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City | TRENTON
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State | ND
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Zip | 58853-9998
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Country | US
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Telephone | 701-774-0461
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Fax | 701-774-8003
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Authorized Official
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Title or Position | ERS
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Name | KELCEY LAWRENCE
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Credential |
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Telephone | 701-572-8316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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