Provider Demographics
NPI:1134329808
Name:STEELE, THERESA MARIE (PSYCHNP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:STEELE
Suffix:
Gender:F
Credentials:PSYCHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14241 GRAND OAKS DRIVE
Mailing Address - Street 2:BAXTER COMMUNITY BEHAVIORAL HEALTH HOSPITAL
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425
Mailing Address - Country:US
Mailing Address - Phone:218-316-3101
Mailing Address - Fax:218-829-9141
Practice Address - Street 1:14241 GRAND OAKS DRIVE
Practice Address - Street 2:BAXTER COMMUNITY BEHAVIORAL HEALTH HOSPITAL
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425
Practice Address - Country:US
Practice Address - Phone:218-316-3101
Practice Address - Fax:218-829-9141
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 104065-8364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult