Healthcare Provider Details

I. General information

NPI: 1215430665
Provider Name (Legal Business Name): MARILYN HOFLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 3RD ST SW
PERHAM MN
56573-1152
US

IV. Provider business mailing address

735 3RD ST SW
PERHAM MN
56573-1152
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-1800
  • Fax:
Mailing address:
  • Phone: 218-347-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: