Individual
SHANE ILJANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
PO BOX 11394, FARGO, ND 58106-1394
(218) 940-2331
Mailing address
PO BOX 11394, FARGO, ND 58106-1394
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
—
Other
Enumeration date
04/10/2025
Last updated
04/10/2025
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