Individual
XTAL SILK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10 N RIVER ROAD, FORT YATES, ND 58538
(701) 854-3831
Mailing address
10 N RIVER ROAD, FORT YATES, ND 58538
(701) 854-3831
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L13880
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609851039
—
ND
Enumeration date
06/27/2018
Last updated
06/27/2018
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