Healthcare Provider Details

I. General information

NPI: 1689705808
Provider Name (Legal Business Name): DEBORAH ONSTAD HANEY RNC, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4915 42ND AVE N
ROBBINSDALE MN
55422-1730
US

IV. Provider business mailing address

8120 60 1/2 AVE.N
NEW HOPE MN
55428-1706
US

V. Phone/Fax

Practice location:
  • Phone: 763-533-1316
  • Fax: 763-531-0315
Mailing address:
  • Phone: 763-533-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR 117718-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: