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NPI Code Detail

MEDICARE: DARLA F DESLAURIERS LAC

MEDICARE: DARLA F DESLAURIERS LAC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor1381ND

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
127211OTHERNDBSND

General Provider Information

NPI Number : 1912093972
Entity Type Code : Individual
Provider Name (Legal Business Name) : DARLA F DESLAURIERS LAC
Provider Business Mailing Address
First Line : 600 22ND AVE NW
Second Line :
City : MINOT
State : ND
Zip : 58703-0986
Country : US
Telephone Number : 701-837-6508
Fax Number : 701-858-1839
Provider Business Practice Location Address
First Line : 600 22ND AVE NW
Second Line :
City : MINOT
State : ND
Zip : 58703-0986
Country : US
Telephone Number : 701-837-6508
Fax Number : 701-858-1839
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2006
Last Update Date : 07/08/2007

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Directions to “ DARLA F DESLAURIERS LAC” Practice Location

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