Provider Demographics
NPI:1437828670
Name:HALVERSON, BRIANNA JO
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:JO
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6120 LAKE ELMO AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9373
Mailing Address - Country:US
Mailing Address - Phone:651-262-9442
Mailing Address - Fax:
Practice Address - Street 1:6600 FRANCE AVE S STE 204
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1800
Practice Address - Country:US
Practice Address - Phone:612-859-7709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist