Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 388 | ND |
NPI | 1023035102 |
---|---|
Provider Name | Dr. Kara Brita Wettersten |
First Address | Grand Forks, ND 58201-5895 |
Second Address | Grand Forks, ND 58201-5895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26772 | BLUE CROSS NORTH DAKOTA (01) | ND |