Individual
KALLIE JO WENNERBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
736 BROADWAY N, FARGO, ND 58102-4421
(701) 234-2000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R43359
ND
Other
Enumeration date
07/12/2022
Last updated
02/03/2023
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