Healthcare Provider Details

I. General information

NPI: 1982651725
Provider Name (Legal Business Name): LYNDA B HOERAUF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MAIN AVE
HEBRON ND
58638-7057
US

IV. Provider business mailing address

3995 COUNTY ROAD 89
HEBRON ND
58638-9381
US

V. Phone/Fax

Practice location:
  • Phone: 701-878-4250
  • Fax:
Mailing address:
  • Phone: 701-878-4228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR15270
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: