Provider Demographics
NPI:1962805549
Name:HALVERSON, TERRI
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:HEINBAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:919 12TH PL
Mailing Address - Street 2:STE 1
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1433
Mailing Address - Country:US
Mailing Address - Phone:928-710-5394
Mailing Address - Fax:
Practice Address - Street 1:ESSENTIA HEALTH DULUTH CLINIC
Practice Address - Street 2:400 EAST THIRD STREET
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-1951
Practice Address - Country:US
Practice Address - Phone:218-786-8364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7342363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology