Individual
MRS. TIFFANY JOY EBLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1884
MN
367500000X
Certified Registered Nurse Anesthetist
Primary
R28198
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108719
NBCRNA
MN
Enumeration date
02/09/2016
Last updated
10/12/2023
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