MEDICARE: OLIVIA PROCHNOW 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
1	3747P1801X	Personal Care Attendant
2	163W00000X	Registered Nurse	200313	ND

General Provider Information

NPI Number	:	1619700283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA PROCHNOW RN

Provider Business Mailing Address
First Line	:	1909 E TRACY LN
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57103-0788
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9470 COUNTY ROAD 1
Second Line	:
City	:	HANKINSON
State	:	ND
Zip	:	58041-9744
Country	:	US
Telephone Number	:	701-640-0515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “ OLIVIA PROCHNOW RN” Practice Location

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