Individual ProviderTodd D UnderdahlNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address737 Broadway, Fargo, ND 58122-0001(701) 234-6258PECOS EnrollmentBased on the most recent information from CMS, provider Todd D Underdahl does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:59 PM.Profile DetailsProvider ID1023039369Provider TypeIndividualFull NameUnderdahl, Todd DCredentialCRNAGenderMaleSole ProprietorNoEnumeration Date7/22/2006Last Updated6/16/2014Contact InformationPractice LocationPractice Address737 Broadway, Fargo, ND 58122-0001Phone(701) 234-6258Fax(701) 234-7334Mailing LocationMailing Address737 Broadway, Fargo, ND 58122-0001Phone(701) 234-6258Fax(701) 234-7334Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR22985North Dakota