Healthcare Provider Details

I. General information

NPI: 1255050191
Provider Name (Legal Business Name): DOROTHY LEE LAROCQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 11/06/2022
Certification Date: 11/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 SUMMIT AVE
HEBRON ND
58638-7305
US

IV. Provider business mailing address

101 F ST S APT 8
GLEN ULLIN ND
58631-7119
US

V. Phone/Fax

Practice location:
  • Phone: 442-354-0188
  • Fax:
Mailing address:
  • Phone: 701-590-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: