Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | PAC0143 | ND |
NPI | 1023035029 |
---|---|
Provider Name | Marie L Brekken |
First Address | Fargo, ND 58103-4940 |
Second Address | Fargo, ND 58103-4940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 27/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R98240 | (02) |