Provider Demographics
NPI:1770994360
Name:TOLLEFSON, HEATHER (RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TOLLEFSON
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 1:10077 DOGWOOD ST NW
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-5286
Mailing Address - Country:US
Mailing Address - Phone:763-792-9471
Mailing Address - Fax:763-792-9472
Practice Address - Street 1:10077 DOGWOOD ST NW
Practice Address - Street 2:SUITE 110
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55448-5286
Practice Address - Country:US
Practice Address - Phone:763-792-9471
Practice Address - Fax:763-792-9472
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR211883163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse