Individual
DEAN EMMETT GUNDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
921 2ND AVE S, FARGO, ND 58103-1705
(701) 361-9922
(701) 829-7140
Mailing address
21 9TH ST S, FARGO, ND 58103-1830
(701) 361-9922
(701) 829-7140
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
00000
ND
172A00000X
Driver
00000
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171M00000X
—
ND
05
—
172A00000X
—
ND
05
—
251B00000X
—
ND
05
—
251S00000X
—
ND
Enumeration date
09/16/2022
Last updated
09/16/2022
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