Provider Demographics
NPI:1528221769
Name:ENGBERG, DACIA C (PA-C)
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:C
Last Name:ENGBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1707 GOLD DR S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6413
Mailing Address - Country:US
Mailing Address - Phone:701-280-3191
Mailing Address - Fax:701-232-5578
Practice Address - Street 1:1707 GOLD DR S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6413
Practice Address - Country:US
Practice Address - Phone:701-280-3191
Practice Address - Fax:701-232-5578
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0392363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical