Provider Demographics
NPI:1710108410
Name:HORTON, NANCY LYNN
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LYNN
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 NODAK DR S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2366
Mailing Address - Country:US
Mailing Address - Phone:701-280-9545
Mailing Address - Fax:
Practice Address - Street 1:1112 NODAK DR S
Practice Address - Street 2:SUITE 200
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2366
Practice Address - Country:US
Practice Address - Phone:701-280-9545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2981104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker