Provider Demographics
NPI:1255050191
Name:LAROCQUE, DOROTHY LEE
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:LEE
Last Name:LAROCQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 F ST S APT 8
Mailing Address - Street 2:
Mailing Address - City:GLEN ULLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58631-7119
Mailing Address - Country:US
Mailing Address - Phone:701-590-9399
Mailing Address - Fax:
Practice Address - Street 1:918 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ND
Practice Address - Zip Code:58638-7305
Practice Address - Country:US
Practice Address - Phone:442-354-0188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDND4726248Medicaid