NPI 1205615192

Elena Shade Fragoza

Practitioner Driver Bismarck, ND

Practice location

Address: 1308 Elbowood Ln, Bismarck, ND 58503-5712
Phone: (701) 751-8267

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence FRA-93-0293 (ND)

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Registry record

NPI: 1205615192
Entity type: Individual
Sex (as registered): Female
NPI issued: 28 Sep 2023
Record last updated: 28 Sep 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.