=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346649829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA DAWN ERMER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2014
-----------------------------------------------------
Last Update Date | 07/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 301 MOUNTAIN ST E
-----------------------------------------------------
City | CAVALIER
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58220-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-265-8461
-----------------------------------------------------
Fax | 701-265-6387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 MOUNTAIN ST E P.O. BOX 380
-----------------------------------------------------
City | CAVALIER
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58220-4015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-265-8461
-----------------------------------------------------
Fax | 701-265-6387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PAC0563
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------