Provider Demographics
NPI:1033139324
Name:FOLKERT, HIEDI (PA-C)
Entity Type:Individual
Prefix:
First Name:HIEDI
Middle Name:
Last Name:FOLKERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 ANNE ST NW # 5
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-6151
Mailing Address - Country:US
Mailing Address - Phone:218-333-5000
Mailing Address - Fax:218-759-4766
Practice Address - Street 1:1705 ANNE ST NW # 5
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-6151
Practice Address - Country:US
Practice Address - Phone:218-333-5000
Practice Address - Fax:218-759-4766
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9098363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S27768Medicare UPIN