=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366728636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE DENISE TORGERSEN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2011
-----------------------------------------------------
Last Update Date | 02/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 STATE AVE
-----------------------------------------------------
City | FARIBAULT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55021-6339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-334-8333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 S BROADWAY
-----------------------------------------------------
City | WELLS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56097-1735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-553-6341
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 286552-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R 2050045
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | R2050045
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------