Provider Demographics
NPI:1306614185
Name:ORTON, DAMION WINTER (FATHER)
Entity type:Individual
Prefix:MR
First Name:DAMION
Middle Name:WINTER
Last Name:ORTON
Suffix:
Gender:M
Credentials:FATHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 AMERICAN AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6646
Mailing Address - Country:US
Mailing Address - Phone:701-390-4516
Mailing Address - Fax:
Practice Address - Street 1:1121 S 11TH ST APT 407
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6632
Practice Address - Country:US
Practice Address - Phone:701-390-4516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDNONEOtherPAYMENT CASH