Provider Demographics
NPI:1437859782
Name:INNOVATIVE HEALTH
Entity Type:Organization
Organization Name:INNOVATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:701-444-2888
Mailing Address - Street 1:PO BOX 1256
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-1256
Mailing Address - Country:US
Mailing Address - Phone:701-444-2888
Mailing Address - Fax:701-444-2813
Practice Address - Street 1:340 N MAIN ST STE 311
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-7308
Practice Address - Country:US
Practice Address - Phone:701-444-2888
Practice Address - Fax:701-444-2813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care