Organization
UNDERWOOD CLINIC PC
Active
Other names
Washburn Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELE LEIDHOLM (OWNER)
(701) 442-3148
Entity
Organization
Contact information
Practice address
87 LINCOLN AVE, UNDERWOOD, ND 58576
(701) 442-3148
(701) 442-3414
Mailing address
PO BOX 253, UNDERWOOD, ND 58576-0253
(701) 442-3148
(701) 442-3414
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
R25051
ND
363LF0000X
Family Nurse Practitioner
Primary
R25469
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06053001
BCBS
ND
01
—
06053002
BCBS
ND
05
—
13448
—
ND
05
—
18607
—
ND
01
—
A63211044293
PREFERRED ONE
—
01
—
A63211046001
PREFERRED ONE
—
01
—
DA6139
RR MEDICARE
—
Enumeration date
08/04/2006
Last updated
10/15/2007
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