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NPI Code Detail

MEDICARE: MALINDA TERESA HENDERSON APRN

MEDICARE: MALINDA TERESA HENDERSON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerR100511-4MN
2363LP0808XPsychiatric/Mental Health Nurse PractitionerR100511-4MN
3363L00000XNurse PractitionerR100511-4MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
132F26HEOTHERMNBLUE CROSS / BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3500005162OTHERMNRAILROAD PROVIDER #

General Provider Information

NPI Number : 1427159854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALINDA TERESA HENDERSON APRN
Provider Business Mailing Address
First Line : 100 FREEMAN DR
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-3504
Country : US
Telephone Number : 507-931-7125
Fax Number : 507-931-7126
Provider Business Practice Location Address
First Line : 100 FREEMAN DR
Second Line :
City : SAINT PETER
State : MN
Zip : 56082-3504
Country : US
Telephone Number : 507-931-7125
Fax Number : 507-931-7126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 08/17/2021

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Directions to “ MALINDA TERESA HENDERSON APRN” Practice Location

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