Individual
AMANDA R WITLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1240 25TH ST S, FARGO, ND 58103-2367
(701) 241-1360
Mailing address
1037 1ST ST N, FARGO, ND 58102-3727
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R43988
ND
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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