Provider Demographics
NPI:1700502309
Name:HERBERG, SUSAN B (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:HERBERG
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:B
Other - Last Name:MATTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 281
Mailing Address - Street 2:
Mailing Address - City:BEARDSLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56211-0281
Mailing Address - Country:US
Mailing Address - Phone:320-305-1101
Mailing Address - Fax:
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1408
Practice Address - Country:US
Practice Address - Phone:320-589-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR52124163WP0807X
MNR52124363LP0808X
CO0998210-NP363LP0808X
MN9826363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15744203Medicaid