Most Relevant Information
Provider Data
| NPI Number: | 1003536426 |
| Provider Name: | CONNIE IDLAND |
| Entity Type: | Individual |
| Taxonomy Code: | 3747P1801X |
| Specialty: | Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 08/29/2022 |
| Last Updated: | 08/29/2022 |
Provider Practice Location
502 1ST ST
TRENTON
ND
588534052
Practice Location Phone/Fax
| Phone: | 4069742294 |
| Fax: |
Provider Mailing Location
PO BOX 725
WILLISTON
ND
588020725
Provider Mailing Phone/Fax
| Phone: | 4069742294 |
| Fax: |