Individual
LILLIANN EMMA RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 212-8626
Mailing address
21 9TH ST S, FARGO, ND 58103-1830
(701) 212-8626
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
00000
ND
175T00000X
Peer Specialist
Primary
00000
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172A0000X
—
ND
05
—
175T00000X
—
ND
Enumeration date
05/09/2022
Last updated
05/09/2022
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