Provider Demographics
NPI:1104224336
Name:DE LA HUNT, TRICA GENE (NP)
Entity type:Individual
Prefix:
First Name:TRICA
Middle Name:GENE
Last Name:DE LA HUNT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:GENE
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:705 5TH ST NW
Mailing Address - Street 2:SUITE D
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-2932
Mailing Address - Country:US
Mailing Address - Phone:218-444-7186
Mailing Address - Fax:
Practice Address - Street 1:705 5TH ST NW
Practice Address - Street 2:SUITE D
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-2932
Practice Address - Country:US
Practice Address - Phone:218-444-7186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-22
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP 3521363LF0000X
MNR177443-2363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily