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Individual

MALINDA TERESA HENDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
100 FREEMAN DR, SAINT PETER, MN 56082-3504
(507) 931-7125
(507) 931-7126
Mailing address
100 FREEMAN DR, SAINT PETER, MN 56082-3504
(507) 931-7125
(507) 931-7126

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R100511-4
MN
363LF0000X
Family Nurse Practitioner
R100511-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
R100511-4
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
32F26HE
BLUE CROSS / BLUE SHIELD
MN
01
500005162
RAILROAD PROVIDER #
MN
05
571822800
MN
Enumeration date
09/26/2006
Last updated
08/17/2021
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