Provider Demographics
NPI:1841777273
Name:LAKEVIEW HEALTH CLINIC
Entity Type:Organization
Organization Name:LAKEVIEW HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:FUCHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-852-8502
Mailing Address - Street 1:2050 36TH AVE SW STE 201
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-7595
Mailing Address - Country:US
Mailing Address - Phone:701-852-8502
Mailing Address - Fax:949-404-8851
Practice Address - Street 1:2050 36TH AVE SW STE 201
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7595
Practice Address - Country:US
Practice Address - Phone:701-852-8502
Practice Address - Fax:949-404-8851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-28
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19744Medicaid