Provider Demographics
NPI:1215901228
Name:HUSTON, LAURIE (FNP)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:HUSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 45TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-9362
Mailing Address - Country:US
Mailing Address - Phone:701-487-3355
Mailing Address - Fax:
Practice Address - Street 1:1101 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6215
Practice Address - Country:US
Practice Address - Phone:701-873-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR25764363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19788Medicaid
NDP40335Medicare UPIN
ND19788Medicaid