MEDICARE: KASAR MAII RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	R38479	ND

General Provider Information

NPI Number	:	1124702527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASAR MAII RN

Provider Business Mailing Address
First Line	:	2877 MCLEOD DR E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8508
Country	:	US
Telephone Number	:	701-540-1239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2877 MCLEOD DR E
Second Line	:
City	:	WEST FARGO
State	:	ND
Zip	:	58078-8508
Country	:	US
Telephone Number	:	701-540-1239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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