Provider Demographics
NPI:1861830275
Name:HOBAN, ALISSA JO (NP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:JO
Last Name:HOBAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALISSA
Other - Middle Name:JO
Other - Last Name:JASKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5800
Mailing Address - Country:US
Mailing Address - Phone:701-234-8820
Mailing Address - Fax:
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-8820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1898020363L00000X
ND33740363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84262Medicaid
NDN719158Medicare PIN
MNH400113977Medicare PIN
ND84262Medicaid