Individual
DESTANY L WANDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 9TH ST S, FARGO, ND 58103-1837
(701) 580-8196
Mailing address
4884 21ST AVE S APT 301, FARGO, ND 58103-7753
(701) 580-8196
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
01/24/2023
Last updated
01/24/2023
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