Individual
KATIE L TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
819 MAIN ST, LISBON, ND 58054-4244
(701) 683-4134
(701) 683-4094
Mailing address
400 E 3RD ST, DULUTH, MN 55805-1951
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PAC0102
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05171
—
ND
01
—
19659
NDBS
ND
Enumeration date
12/08/2005
Last updated
09/12/2019
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