Individual
MILLENNIUM FALCON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 361-9922
Mailing address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 361-9922
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/01/2023
Last updated
06/02/2025
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