Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | CP000683 | SD |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 3420 | MN |
NPI | 1023385887 |
---|---|
Provider Name | Tressa G Dykstra |
First Address | Northfield, MN 55057-2756 |
Second Address | Northfield, MN 55057-2756 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2011 |
Last Update Date | 04/09/2019 |