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General NPI Number Information
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NPI Number | 1790689552
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Entity Type | Individual
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Provider Name | CANDACE MARIE WETTERLUND
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Gender | Female
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 1200 S COLUMBIA ROAD BEHAVIORAL HEALTH - CREDITIALING DEPARTMENT
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City | GRAND FORKS
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State | ND
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Zip | 58201
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Country | US
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Telephone | 701-780-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 315 N WEST AVE
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City | WARREN
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State | MN
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Zip | 56762-1000
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Country | US
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Telephone | 208-305-2640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | R39147
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License Number State | ND
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