| NPI | 1104108695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN LILLESTOL President 701-232-7705 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ND R30611) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2011-09-12 |