Provider Demographics
NPI:1013731488
Name:MORIN, MAYCIE LORAE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAYCIE
Middle Name:LORAE
Last Name:MORIN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MAYCIE
Other - Middle Name:LORAE
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:1300 HOSPITAL LOOP
Mailing Address - Street 2:
Mailing Address - City:BELCOURT
Mailing Address - State:ND
Mailing Address - Zip Code:58316-7712
Mailing Address - Country:US
Mailing Address - Phone:701-477-6111
Mailing Address - Fax:
Practice Address - Street 1:1300 HOSPITAL LOOP
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316-7712
Practice Address - Country:US
Practice Address - Phone:701-477-6111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND201017363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily