Provider Demographics
NPI:1285482273
Name:TAKE HEART PSYCHIATRY LLC
Entity type:Organization
Organization Name:TAKE HEART PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:NICOLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:GINDELE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:320-291-5358
Mailing Address - Street 1:14598 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-6446
Mailing Address - Country:US
Mailing Address - Phone:320-291-5358
Mailing Address - Fax:
Practice Address - Street 1:114 KIDDER ST SE
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3029
Practice Address - Country:US
Practice Address - Phone:320-291-5358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty