Individual
MR. VICTOR WANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC, RN
Contact information
Practice address
112 3RD ST W, SUITE 301, DICKINSON, ND 58601-5136
(701) 483-9150
(701) 483-9150
Mailing address
112 3RD ST W, SUITE 301, DICKINSON, ND 58601-5136
(701) 483-9150
(701) 483-9150
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1132
ND
163W00000X
Registered Nurse
R16926
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09204
BCBS PIN
ND
05
—
54523
—
ND
Enumeration date
07/17/2006
Last updated
04/22/2014
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