Provider Demographics
NPI:1255411906
Name:BONDHUS, TERESA NEWSTROM (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:NEWSTROM
Last Name:BONDHUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 SHOREACRES DR
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-8331
Mailing Address - Country:US
Mailing Address - Phone:763-263-7062
Mailing Address - Fax:
Practice Address - Street 1:531 SHOREACRES DR
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-8331
Practice Address - Country:US
Practice Address - Phone:763-263-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR174780-9171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator