Provider Demographics
NPI:1043422611
Name:NORMAN, BARBARA A (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:NORMAN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 603
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716-0603
Mailing Address - Country:US
Mailing Address - Phone:218-281-3940
Mailing Address - Fax:218-281-6261
Practice Address - Street 1:603 BRUCE ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-2914
Practice Address - Country:US
Practice Address - Phone:218-281-3940
Practice Address - Fax:218-281-6261
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP-3606363LP0808X
NDR18672103TP0016X
MNR158504-5363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1031727OtherPREFERRED ONE
MN164037200Medicaid
MN62 33864OtherUBH MEDICA
MN890000197Medicare ID - Type Unspecified
MN164037200Medicaid