Provider Demographics
NPI:1558966283
Name:PLANTE, GAVIN
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:PLANTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RAILROAD AVE N
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:ND
Mailing Address - Zip Code:58052-4100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 RAILROAD AVE N
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:ND
Practice Address - Zip Code:58052-4100
Practice Address - Country:US
Practice Address - Phone:701-367-1540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant