Provider Demographics
NPI:1427813443
Name:SOLBERG, THANE
Entity type:Individual
Prefix:
First Name:THANE
Middle Name:
Last Name:SOLBERG
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 1:121 UNIVERSITY DR N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4631
Mailing Address - Country:US
Mailing Address - Phone:701-341-1253
Mailing Address - Fax:218-477-1354
Practice Address - Street 1:121 UNIVERSITY DR N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4631
Practice Address - Country:US
Practice Address - Phone:701-341-1253
Practice Address - Fax:218-477-1354
Is Sole Proprietor?:No
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist