Basic Information
| Provider Information | |||||||||
| NPI: | 1962805549 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALVERSON | ||||||||
| FirstName: | TERRI | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | HEINBAUGH | ||||||||
| OtherFirstName: | TERRI | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 919 12TH PL | ||||||||
| Address2: | STE 1 | ||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863051433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287105394 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | ESSENTIA HEALTH DULUTH CLINIC | ||||||||
| Address2: | 400 EAST THIRD STREET | ||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558051951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187868364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2014 | ||||||||
| LastUpdateDate: | 06/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | AP7342 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.