Healthcare Provider Details

I. General information

NPI: 1265456370
Provider Name (Legal Business Name): DEBRA J. LUKENBILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 15TH AVE W
WILLISTON ND
58801-3821
US

IV. Provider business mailing address

PO BOX 5010
MINOT ND
58702-5010
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7477
  • Fax: 701-774-7479
Mailing address:
  • Phone: 701-418-8000
  • Fax: 701-857-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR25574
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: