Individual
LILIAN WATTA BOIMAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4023 51ST WAY S, FARGO, ND 58104-6080
(701) 204-8667
Mailing address
4023 51ST WAY S, FARGO, ND 58104-6080
(701) 204-8667
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-1786436
—
ND
Enumeration date
07/31/2021
Last updated
07/31/2021
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