Individual
TIFFANY S HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1500 109TH AVE NE, BLAINE, MN 55449
(763) 421-5011
Mailing address
1500 109TH AVE NE, BLAINE, MN 55449-4670
(763) 421-5011
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10653
MN
Other
Enumeration date
01/17/2008
Last updated
01/20/2019
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