Healthcare Provider Details

I. General information

NPI: 1750164042
Provider Name (Legal Business Name): CAROL ELAINE HYNEK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 6TH ST SE
STANLEY ND
58784-4444
US

IV. Provider business mailing address

PO BOX 399
STANLEY ND
58784-0399
US

V. Phone/Fax

Practice location:
  • Phone: 701-628-2424
  • Fax:
Mailing address:
  • Phone: 701-628-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR33581
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: