=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548174329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAYLIE HEISLER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2026
-----------------------------------------------------
Last Update Date | 09/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4440 S WASHINGTON ST
-----------------------------------------------------
City | GRAND FORKS
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58201-7245
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-732-7600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 303 22ND ST NW
-----------------------------------------------------
City | EAST GRAND FORKS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56721-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-620-9462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 205312
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 14442
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------