Individual
IVAN MARTIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6355
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6355
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R35181
ND
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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