Healthcare Provider Details

I. General information

NPI: 1417735234
Provider Name (Legal Business Name): KAYLA ESTENSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

1031 7TH ST NE
DEVILS LAKE ND
58301-2719
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-5081
  • Fax:
Mailing address:
  • Phone: 701-662-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL18196
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: