Provider Demographics
NPI:1528300167
Name:HUOT, JEANMARIE CLARA (PA-C)
Entity type:Individual
Prefix:
First Name:JEANMARIE
Middle Name:CLARA
Last Name:HUOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEANMARIE
Other - Middle Name:CLARA
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0190
Mailing Address - Country:US
Mailing Address - Phone:701-587-6060
Mailing Address - Fax:
Practice Address - Street 1:4 N PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-4102
Practice Address - Country:US
Practice Address - Phone:701-587-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1062374133V00000X
363A00000X
NDPAC0734363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1475203Medicaid