Individual
MELISSA MARIE DECOTEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1708 24TH AVE S APT 3, GRAND FORKS, ND 58201-6237
(701) 215-1226
Mailing address
723 N 4TH ST, GRAND FORKS, ND 58203-3223
(701) 620-9979
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
DEC892488
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1474632
—
ND
Enumeration date
11/30/2020
Last updated
11/30/2020
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