Healthcare Provider Details

I. General information

NPI: 1669387023
Provider Name (Legal Business Name): LILIANA LOUISE RAE TRACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 SIERRA COMMONS RD UNIT 535
DICKINSON ND
58601-5167
US

IV. Provider business mailing address

2017 SIERRA COMMONS RD UNIT 535
DICKINSON ND
58601-5167
US

V. Phone/Fax

Practice location:
  • Phone: 701-495-4441
  • Fax: 701-495-4441
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberTRA044015
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: