Healthcare Provider Details

I. General information

NPI: 1326467119
Provider Name (Legal Business Name): LOUELLEN DUCHARME RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 PAGE DR S
FARGO ND
58103-2300
US

IV. Provider business mailing address

17829 HIGHWAY 9 S
BARNESVILLE MN
56514-9223
US

V. Phone/Fax

Practice location:
  • Phone: 651-488-4655
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR29197
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR163478-9
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: