Individual
MS. TONYA JEAN TIDWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1025 MARSH ST, MANKATO, MN 56001
(507) 625-4031
Mailing address
1025 MARSH ST, MANKATO, MN 56001-4752
(507) 625-4031
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10988
MN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/17/2011
Last updated
01/30/2024
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