Healthcare Provider Details

I. General information

NPI: 1255448668
Provider Name (Legal Business Name): CHERYL A. HEFTA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 2ND AVE N
FORT TOTTEN ND
58335
US

IV. Provider business mailing address

4507 HIGHWAY 20
DEVILS LAKE ND
58301-8518
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1251
  • Fax: 701-766-1260
Mailing address:
  • Phone: 701-662-2414
  • Fax: 701-766-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR19042
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: