Provider Demographics
NPI:1730840208
Name:URBAN UNWIND LLC
Entity type:Organization
Organization Name:URBAN UNWIND LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-290-9062
Mailing Address - Street 1:PO BOX 406
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58602-0406
Mailing Address - Country:US
Mailing Address - Phone:701-483-6666
Mailing Address - Fax:701-483-6667
Practice Address - Street 1:30 7TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4335
Practice Address - Country:US
Practice Address - Phone:701-483-6666
Practice Address - Fax:701-483-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-06
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty