Provider Demographics
NPI:1902978455
Name:HONL, BETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:A
Last Name:HONL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 30TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8421
Mailing Address - Country:US
Mailing Address - Phone:701-478-7747
Mailing Address - Fax:701-478-7748
Practice Address - Street 1:4133 30TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8421
Practice Address - Country:US
Practice Address - Phone:701-478-7747
Practice Address - Fax:701-478-7748
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7119207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11917Medicaid
MN246K8HOOtherBLUE SHIELD OF MN
ND024009OtherBLUE SHIELD OF ND
MN026092400Medicaid
MN026092400Medicaid
ND024009OtherBLUE SHIELD OF ND