Individual
SHANKAR EZOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7220 28TH ST S, FARGO, ND 58104-4589
(701) 630-9912
Mailing address
7220 28TH ST S, FARGO, ND 58104-4589
(701) 630-9912
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
08/22/2022
Last updated
01/16/2023
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