Healthcare Provider Details

I. General information

NPI: 1700291895
Provider Name (Legal Business Name): ASHLEY GRACE HUOT DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SHEYENNE ST
WEST FARGO ND
58078-2637
US

IV. Provider business mailing address

1220 SHEYENNE ST
WEST FARGO ND
58078-2637
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4445
  • Fax:
Mailing address:
  • Phone: 701-234-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34451
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: