Healthcare Provider Details

I. General information

NPI: 1093772006
Provider Name (Legal Business Name): BRENDA L HOVERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40520 CO HWY 34 WHITE EARTH HEALTH CENTER
OGEMA MN
56569
US

IV. Provider business mailing address

1007 LEGION ROAD
DETROIT LAKES MN
56501
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-4300
  • Fax: 218-983-6217
Mailing address:
  • Phone: 218-846-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1525270
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR1525270
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberR1525270
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: