Individual
RYAN THORSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 9TH ST S, FARGO, ND 58103-1831
(701) 212-8626
Mailing address
21 9TH ST S, FARGO, ND 58103-1830
(701) 212-8626
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
ND
175T00000X
Peer Specialist
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
251B00000X
—
ND
05
—
251S00000X
—
ND
05
—
347C00000X
—
ND
Enumeration date
03/30/2021
Last updated
03/30/2021
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