Healthcare Provider Details

I. General information

NPI: 1548174329
Provider Name (Legal Business Name): HAYLIE HEISLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S WASHINGTON ST
GRAND FORKS ND
58201-7245
US

IV. Provider business mailing address

303 22ND ST NW
EAST GRAND FORKS MN
56721-1224
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7600
  • Fax:
Mailing address:
  • Phone: 701-620-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number205312
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14442
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: