Provider Demographics
NPI:1861161267
Name:HALLENGREN, THERESA (ARNP-FNP-BC)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:HALLENGREN
Suffix:
Gender:F
Credentials:ARNP-FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 DEVONSHIRE DR NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-1403
Mailing Address - Country:US
Mailing Address - Phone:563-889-0600
Mailing Address - Fax:
Practice Address - Street 1:5264 COUNCIL ST NE STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-2499
Practice Address - Country:US
Practice Address - Phone:319-221-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA133979363LF0000X
IAA165492363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily