Individual
TIMOTHY A WENSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
700 1ST AVE S, FARGO, ND 58103-1802
(701) 234-4086
(701) 234-4024
Mailing address
100 4TH ST S, FARGO, ND 58103-1929
(701) 234-4141
(701) 234-4024
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
LP4423
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12155
—
ND
05
—
764462100
—
MN
Enumeration date
07/22/2006
Last updated
10/29/2008
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