Provider Demographics
NPI:1740935527
Name:GURUNG, KRISHNA
Entity type:Individual
Prefix:
First Name:KRISHNA
Middle Name:
Last Name:GURUNG
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 1:3415 20TH AVE S APT 114
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5784
Mailing Address - Country:US
Mailing Address - Phone:701-864-9049
Mailing Address - Fax:
Practice Address - Street 1:3415 20TH AVE S APT 114
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5784
Practice Address - Country:US
Practice Address - Phone:701-864-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-19
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant