Healthcare Provider Details

I. General information

NPI: 1255934931
Provider Name (Legal Business Name): BRIDGET LYNN DENAULT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HORSESHOE BND
HORACE ND
58047-5717
US

IV. Provider business mailing address

5 HORSESHOE BND
HORACE ND
58047-5718
US

V. Phone/Fax

Practice location:
  • Phone: 701-282-8152
  • Fax:
Mailing address:
  • Phone: 701-306-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberND3242698
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: