Provider Demographics
NPI:1164102083
Name:MALTERUD, DUANE (DNP)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:
Last Name:MALTERUD
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30502 360TH ST
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:MN
Mailing Address - Zip Code:56461-4043
Mailing Address - Country:US
Mailing Address - Phone:218-556-7228
Mailing Address - Fax:
Practice Address - Street 1:190 SAILSTAR DRIVE NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633
Practice Address - Country:US
Practice Address - Phone:218-335-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10385363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care