NPIMap

Individual provider Active NPI

Jenni Anne Tharaldson, CNP

  • Adult Health Nurse Practitioner
  • Duluth, MN
National Provider Identifier
1457633760
Registry record updated Sep 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
R181016-3 Issued in MN
Practice address
400 E 3Rd St
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Sep 13, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X R181016-3 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111222000456 MN Practitioner - Nurse Practitioner 1153597125 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Hospital & facility affiliations

  • Essentia Health Duluth Hospital, Duluth, MN, CCN 240019
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002
  • Essentia Health Virginia Hospital, Virginia, MN, CCN 240084
  • Essentia Health Moose Lake Hospital, Moose Lake, MN, CCN 241350
  • North Shore Health Hospital, Grand Marais, MN, CCN 241317

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R181016-3MNMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Deer River Healthcare Center, Inc. CurrentSince Mar 1, 2019 Accepting new patients
Essentia Health Moose Lake CurrentSince Sep 7, 2021 Accepting new patients
St. Mary'S Medical Center CurrentSince Oct 1, 2024 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Oct 10, 2011 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD CurrentSince Oct 10, 2011 Accepting new patients
Deer River Healthcare Center, Inc. Current Accepting new patients
Essentia Health Moose Lake Current Accepting new patients
Deer River Healthcare Center, Inc CurrentSince Mar 1, 2019 Accepting new patients
St Marys Medical Center CurrentSince Oct 1, 2024 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
The Duluth Clinic LTD Current Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients

Locations

115 10th Ave NE
Deer River, MN 56636
Phone (218) 246-2900

115 10th Ave NE
#A
Deer River, MN 56636
Phone (218) 246-8275

402 E 2nd St
Duluth, MN 55805
Phone (218) 786-3443

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

4855 W Arrowhead Rd
Hermantown, MN 55811
Phone (218) 786-3540

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

603 9th St N
Virginia, MN 55792
Phone (218) 741-3013

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

Organizations & group practices 13

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 13

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315872000000",
    "number": "1457633760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THARALDSON",
        "first_name": "JENNI",
        "middle_name": "ANNE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MN",
            "license": "R181016-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.