Provider Demographics
NPI:1609078302
Name:ROGNESS, CORRIE LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:CORRIE
Middle Name:LYNN
Last Name:ROGNESS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY DR
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-4731
Mailing Address - Country:US
Mailing Address - Phone:701-748-3334
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHWAY DR
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4731
Practice Address - Country:US
Practice Address - Phone:701-748-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29761363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND499OtherG-FAMILY NURSE PRACTITION