Lake Medical, PLLC
Nurse Practitioner, Family in Bottineau, ND. Organization (NPI-2).
NPI number1780425546
StatusActive
Last updated in NPPESJun 5, 2024
Details
- NPI
- 1780425546
- Entity type
- Organization (NPI-2)
- Legal business name
- Lake Medical, PLLC
- Organization subpart
- No
- Enumeration date
- Jun 5, 2024
- Certification date
- Jun 5, 2024
- Last updated
- Jun 5, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | – | – | Yes |
Practice location
1475 108th St NeBottineau, ND 58318-8026
Phone 701-228-4226
Mailing address
1475 108th St NeBottineau, ND 58318-8026
Phone 701-228-4226
Authorized official
Jana Knutson
Owner
7012284226
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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