Provider Demographics
NPI:1811654239
Name:DALBERG, ANDREW LEE
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:LEE
Last Name:DALBERG
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 1:1806 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2417
Mailing Address - Country:US
Mailing Address - Phone:605-268-0667
Mailing Address - Fax:
Practice Address - Street 1:1806 8TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2417
Practice Address - Country:US
Practice Address - Phone:605-268-0667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care