Individual
MR. MICHAEL J ROGNLIEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2301 25TH ST S, SUITE A, FARGO, ND 58103-6104
(701) 237-9712
(701) 237-0922
Mailing address
2301 25TH ST S, SUITE A, FARGO, ND 58103-6104
(701) 237-9712
(701) 237-0922
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0239
ND
363AM0700X
Medical Physician Assistant
PAC0239
ND
363AS0400X
Surgical Physician Assistant
PAC0239
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
15848
—
ND
Enumeration date
05/25/2006
Last updated
01/06/2011
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