Healthcare Provider Details

I. General information

NPI: 1649367004
Provider Name (Legal Business Name): NOLA DAHLEN LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHWAY 2 W
DEVILS LAKE ND
58301-3532
US

IV. Provider business mailing address

PO BOX 650
DEVILS LAKE ND
58301-0650
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-2200
  • Fax: 701-665-2300
Mailing address:
  • Phone: 701-665-2200
  • Fax: 701-665-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number803
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateND

VII. Legacy identifiers

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

# 1
Identifier054518
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: