Provider Demographics
NPI:1902274236
Name:HINNENKAMP, THERESE
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:HINNENKAMP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 GRIMSRUD DR APT 309
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-8127
Mailing Address - Country:US
Mailing Address - Phone:651-308-1054
Mailing Address - Fax:
Practice Address - Street 1:2112 GRIMSRUD DR APT 309
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-8127
Practice Address - Country:US
Practice Address - Phone:651-308-1054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer