Provider Demographics
NPI:1578270351
Name:DUCKSTAD, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DUCKSTAD
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 1:930 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58203-2408
Mailing Address - Country:US
Mailing Address - Phone:701-795-9143
Mailing Address - Fax:701-772-5560
Practice Address - Street 1:930 N 3RD ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58203-2408
Practice Address - Country:US
Practice Address - Phone:701-795-9143
Practice Address - Fax:701-772-5560
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174400000XOther Service ProvidersSpecialist