Alisa T Mitskog

NPI 1184923179 - Clinic/Center - 261Q00000X

NPI Details
NPI 1184923179
Enumeration Date 03/16/2011
Last Updated 10/13/2015
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name ALISA T ALISA
Position PRESIDENT
Phone (701) 642-6444
Fax
Practice Location
319 11TH ST N
WAHPETON ND, 58075-4111, US
Phone (701) 642-6444
Fax
Business Location
PO BOX 1461
WAHPETON ND, 58074-1461, US
Phone (701) 642-6444
Fax
Toxanomy
Taxonomy Code 261Q00000X
License State North Dakota
License Number 500
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According to our database, Alisa T Mitskog NPI is 1184923179, taxonomy code is 261Q00000X and license number is 500, license state is located at North Dakota. Alisa T Mitskog physically located at 319 11th St N, Wahpeton ND, 58075-4111. NPI Number 1033115704 has the healthcare provider type.

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1184923179 NPI number is provided on an as is basis without warranty of any kind. 1184923179 is maintained by the National Plan & Provider Enumeration System. The contents of Alisa T Mitskog are for informational purposes only.