Healthcare Provider Details

I. General information

NPI: 1245284314
Provider Name (Legal Business Name): LAURA ARCHULETA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 SUNSET DRIVE NW
MANDAN ND
58554
US

IV. Provider business mailing address

PO BOX 997
BISMARCK ND
58502-0997
US

V. Phone/Fax

Practice location:
  • Phone: 701-667-4600
  • Fax: 701-530-3780
Mailing address:
  • Phone: 701-667-4600
  • Fax: 701-530-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9721
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number9721
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: