Provider Demographics
NPI:1760078760
Name:NORTH COUNTRY PSYCHIATRY
Entity Type:Organization
Organization Name:NORTH COUNTRY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE-MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUN
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:612-708-4754
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:NERSTRAND
Mailing Address - State:MN
Mailing Address - Zip Code:55053-0111
Mailing Address - Country:US
Mailing Address - Phone:612-708-4754
Mailing Address - Fax:
Practice Address - Street 1:1082 HIGHWAY 3 S
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-3088
Practice Address - Country:US
Practice Address - Phone:507-301-6657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-15
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty