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General NPI Number Information
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NPI Number | 1174184717
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Entity Type | Individual
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Provider Name | ZACHARY B HOROSHAK PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/25/2019
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Last Update Date | 08/06/2019
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Provider Practice Location Address
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Address Line | 901 9TH ST N
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City | VIRGINIA
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State | MN
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Zip | 55792-2325
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Country | US
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Telephone | 218-741-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 1702 UNIVERSITY DR S
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City | FARGO
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State | ND
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Zip | 58103-4940
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 13083
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License Number State | MN
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