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NPI Code Detail

MEDICARE: MR. CURTIS LEE CAVALIER RN

MEDICARE: MR. CURTIS LEE CAVALIER RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR1168873MN
2163W00000XRegistered NurseR20078ND

General Provider Information

NPI Number : 1447470075
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CURTIS LEE CAVALIER RN
Provider Business Mailing Address
First Line : 2209 33RD AVE SO
Second Line :
City : MOORHEAD
State : MN
Zip : 56560
Country : US
Telephone Number : 218-236-7053
Fax Number : 218-236-7053
Provider Business Practice Location Address
First Line : 106 NORTH 4TH AVENUE
Second Line :
City : FERGUS FALLS
State : MN
Zip : 56537-1034
Country : US
Telephone Number : 218-998-3778
Fax Number : 218-998-3187
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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