Healthcare Provider Details

I. General information

NPI: 1225027519
Provider Name (Legal Business Name): LORETTA PFEIFER PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOUTH 7TH STREET
OAKES ND
58474-2024
US

IV. Provider business mailing address

PO BOX 50
OAKES ND
58474-0050
US

V. Phone/Fax

Practice location:
  • Phone: 701-742-3267
  • Fax: 701-742-3201
Mailing address:
  • Phone: 701-742-3267
  • Fax: 701-742-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAC0196
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: