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NPI Code Detail

MEDICARE: THERESE HOUNDT-DALBERG APRN, PMHNP-BC

MEDICARE: THERESE HOUNDT-DALBERG APRN, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR167451MN
2363LP0808XPsychiatric/Mental Health Nurse Practitioner8497MN

General Provider Information

NPI Number : 1861858466
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESE HOUNDT-DALBERG APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 570 PROFESSIONAL DR
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-2756
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 570 PROFESSIONAL DR
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-2756
Country : US
Telephone Number : 507-301-3412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2016
Last Update Date : 11/13/2021

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