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General NPI Number Information
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NPI Number | 1326775420
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Entity Type | Organization
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Legal Business Name | HERSELF HEALTH MN PC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 2004 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-1931
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Country | US
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Telephone | 612-256-8225
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Fax | 612-457-0216
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Provider Business Mailing Address
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Address Line | 2004 FORD PKWY
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City | SAINT PAUL
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State | MN
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Zip | 55116-1931
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Country | US
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Telephone | 612-256-8225
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Fax | 651-457-0216
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DEBORAH DITTBERNER
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Credential | MD
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Telephone | 888-290-1209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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