Healthcare Provider Details

I. General information

NPI: 1083421200
Provider Name (Legal Business Name): SIERRA DAWN FLYING HORSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10092 37T ST NW
NEW TOWN ND
58763-7701
US

IV. Provider business mailing address

PO BOX 434
NEW TOWN ND
58763-0434
US

V. Phone/Fax

Practice location:
  • Phone: 701-898-8787
  • Fax:
Mailing address:
  • Phone:
  • 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: