Provider Demographics
NPI:1376202416
Name:HOULE, GWENDOLYN M
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:M
Last Name:HOULE
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 926
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329-0926
Mailing Address - Country:US
Mailing Address - Phone:605-214-2886
Mailing Address - Fax:
Practice Address - Street 1:38 SW 2ND ST
Practice Address - Street 2:LOT 38
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329
Practice Address - Country:US
Practice Address - Phone:605-214-2886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care