Provider Demographics
NPI:1134726821
Name:PROCIVE, LANA J (LMT)
Entity type:Individual
Prefix:MRS
First Name:LANA
Middle Name:J
Last Name:PROCIVE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 158
Mailing Address - Street 2:
Mailing Address - City:BELFIELD
Mailing Address - State:ND
Mailing Address - Zip Code:58622-0158
Mailing Address - Country:US
Mailing Address - Phone:701-575-4725
Mailing Address - Fax:
Practice Address - Street 1:517 6TH ST NE
Practice Address - Street 2:
Practice Address - City:BELFIELD
Practice Address - State:ND
Practice Address - Zip Code:58622-0158
Practice Address - Country:US
Practice Address - Phone:701-575-4725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND17119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist