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General NPI Number Information
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NPI Number | 1962805549
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Entity Type | Individual
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Provider Name | TERRI HALVERSON
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Gender | Female
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Dates
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Enumeration Date | 09/26/2014
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | ESSENTIA HEALTH DULUTH CLINIC 400 EAST THIRD STREET
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City | DULUTH
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State | MN
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Zip | 55805-1951
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Country | US
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Telephone | 218-786-8364
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Fax |
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Provider Business Mailing Address
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Address Line | 919 12TH PL STE 1
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City | PRESCOTT
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State | AZ
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Zip | 86305-1433
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Country | US
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Telephone | 928-710-5394
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | AP7342
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License Number State | AZ
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