Individual
MARTHA ANNE TACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1804 TROTT AVE SW, WILLMAR, MN 56201-2743
(320) 214-7286
Mailing address
1804 TROTT AVE SW, WILLMAR, MN 56201-2743
(320) 214-7286
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11149
MN
Other
Enumeration date
12/29/2023
Last updated
12/29/2023
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