Individual
BRENT WIEDERHOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
N10 NORTH RIVER ROAD, FORT YATES, ND 58538
(701) 854-3831
Mailing address
PO BOX J, FORT YATES, ND 58538-0527
(701) 854-3831
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
R033677
SD
363LF0000X
Family Nurse Practitioner
Primary
SD-CNP CP000967
SD
Other
Enumeration date
06/20/2008
Last updated
07/23/2015
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