Provider Demographics
NPI:1346992286
Name:KINDSVOGEL, EDEN GRACE
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:GRACE
Last Name:KINDSVOGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:ND
Mailing Address - Zip Code:58530-0053
Mailing Address - Country:US
Mailing Address - Phone:701-207-0181
Mailing Address - Fax:
Practice Address - Street 1:802 5TH ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-2511
Practice Address - Country:US
Practice Address - Phone:701-202-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-21
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant