Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO2459 | ME |
Y | 207Q00000X | Family Doctor | 14123 | ND |
N | 207Q00000X | Family Doctor | 64569 | MN |
N | 207Q00000X | Family Doctor | DO2459 | ME |
NPI | 1336412352 |
---|---|
Provider Name | Allison Laura Hetland |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58103-5800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 25/02/2021 |