Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 9721 | ND |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 9721 | ND |
NPI | 1245284314 |
---|---|
Provider Name | Laura Archuleta |
First Address | Bismarck, ND 58502-0997 |
Second Address | Mandan, ND 58554 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2006 |
Last Update Date | 20/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1454485 | (05) | ND |
H75006 | (02) | ND |