Provider Demographics
NPI:1639703861
Name:WOLBERG, NATALIE J (LMT)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:J
Last Name:WOLBERG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:J
Other - Last Name:STICKA SUNDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:102 BEATON DR. SUITE #101
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078
Mailing Address - Country:US
Mailing Address - Phone:701-799-9802
Mailing Address - Fax:701-893-2638
Practice Address - Street 1:102 BEATON DR. SUITE #101
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078
Practice Address - Country:US
Practice Address - Phone:701-799-9802
Practice Address - Fax:701-893-2638
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND434225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist