Individual
KIMBERLY HAWK EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10 N RIVER ROAD, FORT YATES, ND 58538
(701) 854-3831
Mailing address
PO BOX J, FORT YATES, ND 58538-0527
(701) 854-3831
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L14719
ND
Other
Enumeration date
09/11/2015
Last updated
02/13/2020
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