Healthcare Provider Details

I. General information

NPI: 1962805549
Provider Name (Legal Business Name): TERRI HALVERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI HEINBAUGH

II. Dates (important events)

Enumeration Date: 09/26/2014
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ESSENTIA HEALTH DULUTH CLINIC 400 EAST THIRD STREET
DULUTH MN
55805-1951
US

IV. Provider business mailing address

919 12TH PL STE 1
PRESCOTT AZ
86305-1433
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-8364
  • Fax:
Mailing address:
  • Phone: 928-710-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP7342
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: