Individual
TAHEREH KESHAVARZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 1ST AVE S, MERITCARE NEUROSCIENCE CLINIC -, FARGO, ND 58103
(701) 234-4036
(701) 234-4134
Mailing address
700 1ST AVE S, MERITCARE NEUROSCIENCE CLINIC, FARGO, ND 58103
(701) 234-4036
(701) 234-4134
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PAC0409
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71175
—
ND
Enumeration date
02/17/2009
Last updated
11/21/2012
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