Basic Information
| Provider Information | |||||||||
| NPI: | 1588900500 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS ADMINISTRATION HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581022417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
| FaxNumber: | 7012372649 | ||||||||
| Practice Location | |||||||||
| Address1: | 2101 ELM ST N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581022417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012393700 | ||||||||
| FaxNumber: | 7012372649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | SOISETH | ||||||||
| AuthorizedOfficialFirstName: | DANELLE | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | MARRIAGE AND FAMILY THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 7012393700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4286 | ND | Y | Hospitals | General Acute Care Hospital |
No ID Information.