Healthcare Provider Details

I. General information

NPI: 1508374455
Provider Name (Legal Business Name): ANDREA HOGSTAD CDE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA RIVARD RN

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-2000
  • Fax: 701-234-2345
Mailing address:
  • Phone: 701-234-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number1827392
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number21700804
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: