=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386460970
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAILEY KATE GREGOR RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/27/2024
-----------------------------------------------------
Last Update Date | 11/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 MAIN ST
-----------------------------------------------------
City | LISBON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58054-4334
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-683-6400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1309 ASH ST
-----------------------------------------------------
City | LISBON
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58054-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-240-9088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WE0003X
-----------------------------------------------------
Taxonomy Name | Emergency Registered Nurse
-----------------------------------------------------
License Number | R51387
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------