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NPI Code Detail

MEDICARE: MRS. BRITT ERIKA NYSTROMBALFE LICSW

MEDICARE: MRS. BRITT ERIKA NYSTROMBALFE LICSW
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
11041C0700XClinical Social Worker16590MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
141-1576550OTHERPRACTICE FED TAX ID#

General Provider Information

NPI Number : 1831290543
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BRITT ERIKA NYSTROMBALFE LICSW
Provider Business Mailing Address
First Line : 4933 SHERIDAN AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55410-1920
Country : US
Telephone Number : 612-920-0749
Fax Number :
Provider Business Practice Location Address
First Line : 3450 OLEARY LN
Second Line :
City : EAGAN
State : MN
Zip : 55123-2340
Country : US
Telephone Number : 651-454-0114
Fax Number : 651-454-3492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2006
Last Update Date : 07/08/2007

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