Individual
SHASTA MANDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N., C.D.E.
Contact information
Practice address
1058 COLLEGE DR, NEW TOWN, ND 58763-9112
(701) 627-7931
Mailing address
1058 COLLEGE DR, NEW TOWN, ND 58763-9112
(701) 627-7931
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
R29464
ND
Other
Enumeration date
06/01/2016
Last updated
06/01/2016
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