Provider Demographics
NPI:1871684530
Name:D & L PC
Entity Type:Organization
Organization Name:D & L PC
Other - Org Name:QUALITY LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:JOANN
Authorized Official - Last Name:VOLNESS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:701-478-0333
Mailing Address - Street 1:PO BOX 2309
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-2309
Mailing Address - Country:US
Mailing Address - Phone:701-478-0333
Mailing Address - Fax:701-478-0434
Practice Address - Street 1:1316 23RD ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3707
Practice Address - Country:US
Practice Address - Phone:701-478-0333
Practice Address - Fax:701-478-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR21956364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN256945100Medicaid
ND711684Medicare PIN
MN256945100Medicaid