Provider Demographics
NPI:1568299758
Name:POITRA, NICOLE MARIE (CNA QSP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:POITRA
Suffix:
Gender:F
Credentials:CNA QSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:DUNSEITH
Mailing Address - State:ND
Mailing Address - Zip Code:58329-2920
Mailing Address - Country:US
Mailing Address - Phone:701-228-4922
Mailing Address - Fax:
Practice Address - Street 1:116 2ND ST NW
Practice Address - Street 2:
Practice Address - City:DUNSEITH
Practice Address - State:ND
Practice Address - Zip Code:58329-2920
Practice Address - Country:US
Practice Address - Phone:701-228-4922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND41680376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide