Provider Demographics
NPI:1225027519
Name:PFEIFER, LORETTA (PAC)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0050
Mailing Address - Country:US
Mailing Address - Phone:701-742-3267
Mailing Address - Fax:701-742-3201
Practice Address - Street 1:420 SOUTH 7TH STREET
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0196363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND71114Medicaid
ND28592OtherBLUE SHIELD
ND18203OtherBLUE SHIELD
ND28591OtherBLUE SHIELD
ND28593OtherBLUE SHIELD
ND970009830OtherRAILROAD MEDICARE
NDCF8850OtherRAILROAD MEDICARE
ND18205OtherBLUE SHIELD
ND25984OtherBLUE SHIELD
ND28590OtherBLUE SHIELD
ND28592OtherBLUE SHIELD
NDCF8850Medicare PIN
NDN715188Medicare PIN
ND25984OtherBLUE SHIELD
NDN18203Medicare PIN