Healthcare Provider Details

I. General information

NPI: 1396565628
Provider Name (Legal Business Name): MEGAN HOFLAND RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MAIN ST E
OGEMA MN
56569-6911
US

IV. Provider business mailing address

407 MAIN ST E
OGEMA MN
56569-6911
US

V. Phone/Fax

Practice location:
  • Phone: 218-983-3900
  • Fax:
Mailing address:
  • Phone: 218-983-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR45652
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: