Provider Demographics
NPI:1659004711
Name:DYKSTRA DBP
Entity Type:Organization
Organization Name:DYKSTRA DBP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TRESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:712-441-2748
Mailing Address - Street 1:1309 THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-3110
Mailing Address - Country:US
Mailing Address - Phone:712-441-2748
Mailing Address - Fax:
Practice Address - Street 1:1309 THOMAS CT
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3110
Practice Address - Country:US
Practice Address - Phone:712-441-2748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health