Healthcare Provider Details

I. General information

NPI: 1184031759
Provider Name (Legal Business Name): ETHAN HOEPFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N 8TH ST
BISMARCK ND
58501-3929
US

IV. Provider business mailing address

800 N 8TH ST
BISMARCK ND
58501-3929
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-4800
  • Fax:
Mailing address:
  • Phone: 701-323-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4997
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4997
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: