| Cqtpsychiatry | |
|
4135 Richard Ave Ste 201 Hermantown MN 55811-2979 | |
| (612) 429-1011 | |
| Not Available |
| Full Name | Cqtpsychiatry |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 4135 Richard Ave Ste 201, Hermantown, Minnesota |
| Authorized Official Name and Position | Joannah Bluntach (DR.) |
| Authorized Official Contact | 2189691347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cqtpsychiatry 4135 Richar Avenue Suite 201 Hermantown MN 55811-8009 Ph: (218) 969-1347 | Cqtpsychiatry 4135 Richard Ave Ste 201 Hermantown MN 55811-2979 Ph: (612) 429-1011 |
| NPI Number | 1932852860 |
|---|---|
| Provider Enumeration Date | 01/31/2022 |
| Last Update Date | 02/07/2023 |
| Certification Date | 02/07/2023 |
| Medicare PECOS PAC ID | 9537533013 |
|---|---|
| Medicare Enrollment ID | O20230323002817 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932852860 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Nadine T Hoven |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1487872107 PECOS PAC ID: 2163608209 Enrollment ID: I20110525000424 |
| Provider Name | Joannah B Bluntach |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902293855 PECOS PAC ID: 5597086694 Enrollment ID: I20150601002627 |
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