Provider Demographics
NPI:1437822079
Name:MORTENSON, AWNA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AWNA
Middle Name:MARIE
Last Name:MORTENSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2605
Mailing Address - Country:US
Mailing Address - Phone:701-225-4421
Mailing Address - Fax:
Practice Address - Street 1:2265 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2605
Practice Address - Country:US
Practice Address - Phone:701-225-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH6328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist