Provider Demographics
NPI:1821693805
Name:WOLLENZIEN, BENJAMIN JAMES
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:JAMES
Last Name:WOLLENZIEN
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:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:TOWNER
Mailing Address - State:ND
Mailing Address - Zip Code:58788-0181
Mailing Address - Country:US
Mailing Address - Phone:701-537-0524
Mailing Address - Fax:
Practice Address - Street 1:101 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:TOWNER
Practice Address - State:ND
Practice Address - Zip Code:58788-0181
Practice Address - Country:US
Practice Address - Phone:701-537-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14542103747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant