Individual
NWACHAN I NDI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3704 42ND ST S APT 201, FARGO, ND 58104-7935
(701) 885-1187
Mailing address
3704 42ND ST S APT 201, FARGO, ND 58104-7935
(701) 885-1187
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
376J00000X
Homemaker
—
—
Other
Enumeration date
12/18/2025
Last updated
12/18/2025
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