Healthcare Provider Details

I. General information

NPI: 1962336032
Provider Name (Legal Business Name): STEPHANIE MARIE HAUGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 OXFORD ST
GRAND FORKS ND
58202-6092
US

IV. Provider business mailing address

430 OXFORD ST
GRAND FORKS ND
58202-6092
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-4174
  • Fax:
Mailing address:
  • Phone: 701-777-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204302
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: