Provider Demographics
NPI:1255017455
Name:IRON CLOUD, WOPILAH (LPN)
Entity type:Individual
Prefix:
First Name:WOPILAH
Middle Name:
Last Name:IRON CLOUD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 ELBOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-5712
Mailing Address - Country:US
Mailing Address - Phone:701-751-8260
Mailing Address - Fax:701-751-2274
Practice Address - Street 1:1308 ELBOWOOD LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-5712
Practice Address - Country:US
Practice Address - Phone:701-751-8260
Practice Address - Fax:701-751-2274
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM62402164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse