Provider Demographics
NPI:1316936693
Name:HOISTAD, JEANNE (PAC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:HOISTAD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-0050
Mailing Address - Country:US
Mailing Address - Phone:701-742-3267
Mailing Address - Fax:701-742-3201
Practice Address - Street 1:420 SOUTH7TH STREET
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-2024
Practice Address - Country:US
Practice Address - Phone:701-742-3267
Practice Address - Fax:701-742-3201
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0108363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND28589OtherBLUE SHIELD
ND970009834OtherRAILROAD MEDICARE
ND18208OtherBLUE SHIELD
ND18207OtherBLUE SHIELD
ND28587OtherBLUE SHIELD
ND28588OtherBLUE SHIELD
ND18181OtherBLUE SHIELD
ND25948OtherBLUE SHIELD
NDCF8850OtherRAILROAD MEDICARE
NDN18181Medicare Oscar/Certification
NDCF8850Medicare PIN
ND25948OtherBLUE SHIELD
ND28587OtherBLUE SHIELD
ND28588OtherBLUE SHIELD