Provider Demographics
NPI:1538768130
Name:PRITCHARD, DARREL
Entity type:Individual
Prefix:
First Name:DARREL
Middle Name:
Last Name:PRITCHARD
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 1:7257 99TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646-9267
Mailing Address - Country:US
Mailing Address - Phone:719-660-0043
Mailing Address - Fax:
Practice Address - Street 1:7257 99TH AVE SW
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646-9267
Practice Address - Country:US
Practice Address - Phone:719-660-0043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND4634761Medicaid