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General NPI Number Information
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NPI Number | 1316638448
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Entity Type | Organization
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Legal Business Name | RESILIENT PSYCHIATRY L.L.C.
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Dates
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Enumeration Date | 05/18/2023
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 5460 LONGVIEW CT UNIT 3
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City | JOHNSTON
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State | IA
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Zip | 50131-2725
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Country | US
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Telephone | 515-537-9686
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Fax | 515-384-0107
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Provider Business Mailing Address
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Address Line | 5460 LONGVIEW CT UNIT 3
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City | JOHNSTON
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State | IA
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Zip | 50131-2725
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Country | US
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Telephone | 515-537-9686
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Fax | 515-384-0107
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Authorized Official
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Title or Position | PMHNP-BC
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Name | TAMARA SUE HALBERSMA
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Credential | ARNP
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Telephone | 515-537-9686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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