Robert Tack
Nurse Practitioner, Psych/Mental Health in Waite Park, MN. Individual provider (NPI-1).
NPI number1578400289
StatusActive
Last updated in NPPESApr 30, 2026
Details
- NPI
- 1578400289
- Entity type
- Individual (NPI-1)
- Name
- Robert Tack
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 30, 2026
- Certification date
- Apr 30, 2026
- Last updated
- Apr 30, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 14074 | MN | Yes |
Practice location
209 3rd St NeWaite Park, MN 56387-1271
Phone 320-968-6023
Mailing address
209 3rd St NeWaite Park, MN 56387-1271
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