Provider Demographics
NPI:1538867601
Name:VETTER, WILLIAM DAKOTA
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DAKOTA
Last Name:VETTER
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 1:3219 18TH ST S APT 105
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-5907
Mailing Address - Country:US
Mailing Address - Phone:701-730-9336
Mailing Address - Fax:
Practice Address - Street 1:3219 18TH ST S APT 105
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-5907
Practice Address - Country:US
Practice Address - Phone:701-730-9336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant