Provider Demographics
NPI:1508575416
Name:WEBER-RODLUND, PEGGY
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:WEBER-RODLUND
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 232
Mailing Address - Street 2:
Mailing Address - City:SELFRIDGE
Mailing Address - State:ND
Mailing Address - Zip Code:58568-0232
Mailing Address - Country:US
Mailing Address - Phone:701-230-2378
Mailing Address - Fax:
Practice Address - Street 1:110 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SELFRIDGE
Practice Address - State:ND
Practice Address - Zip Code:58568-7706
Practice Address - Country:US
Practice Address - Phone:701-230-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172A00000XOther Service ProvidersDriver
No175T00000XOther Service ProvidersPeer Specialist