Healthcare Provider Details

I. General information

NPI: 1992340194
Provider Name (Legal Business Name): MARIT LEIGH THRONTVEIT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

IV. Provider business mailing address

45 10TH ST W
SAINT PAUL MN
55102-1062
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6996
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: