Healthcare Provider Details

I. General information

NPI: 1285094318
Provider Name (Legal Business Name): KATHLEEN HALBERT FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY HALBERT FNP-BC

II. Dates (important events)

Enumeration Date: 03/02/2016
Last Update Date: 12/12/2019
Certification Date: 12/12/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BUNKER HILL DR
AITKIN MN
56431-1865
US

IV. Provider business mailing address

PO BOX 1154
BRAINERD MN
56401-1154
US

V. Phone/Fax

Practice location:
  • Phone: 218-927-2157
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-4291
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: