Provider Demographics
NPI:1942526132
Name:PRAIRIE NATUROPATHIC DOCTORS, LLC
Entity Type:Organization
Organization Name:PRAIRIE NATUROPATHIC DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LTM
Authorized Official - Phone:218-284-1188
Mailing Address - Street 1:1904 30TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-5210
Mailing Address - Country:US
Mailing Address - Phone:218-284-1188
Mailing Address - Fax:218-284-1190
Practice Address - Street 1:1904 30TH AVE S
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-5210
Practice Address - Country:US
Practice Address - Phone:218-284-1188
Practice Address - Fax:218-284-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1003175F00000X
MN1012175F00000X, 291U00000X
MN1022176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No176B00000XOther Service ProvidersMidwifeGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty