Organization
RED RIVER NEUROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORAE BENSON (MANAGER)
(701) 780-1401
Entity
Organization
Contact information
Practice address
2812 17TH AVE S, STE D, GRAND FORKS, ND 58201-4048
(701) 780-1401
(701) 780-1404
Mailing address
2812 17TH AVE S, STE D, GRAND FORKS, ND 58201-4048
(701) 780-1401
(701) 780-1404
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
4231
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16549
—
ND
Enumeration date
06/28/2005
Last updated
08/22/2020
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