Individual
MARIE ITELA DORESTANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
733 WALTER WAY, BISMARCK, ND 58503-1193
(701) 934-4248
Mailing address
733 WALTER WAY, BISMARCK, ND 58503-1193
(701) 934-4248
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
59196
ND
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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