Healthcare Provider Details

I. General information

NPI: 1962461616
Provider Name (Legal Business Name): ERIC HALVERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 21ST ST W SUITE D1
DICKINSON ND
58601-2647
US

IV. Provider business mailing address

448 21ST ST W SUITE D1
DICKINSON ND
58601-2647
US

V. Phone/Fax

Practice location:
  • Phone: 701-483-1000
  • Fax: 701-483-1001
Mailing address:
  • Phone: 701-483-1000
  • Fax: 701-483-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number911
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: