Individual
ELICE K. G. TIEGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007
(507) 263-4221
Mailing address
404 W FOUNTAIN ST, ALBERT LEA, MN 56007-2437
(507) 263-4221
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
1523780
MN
363L00000X
Nurse Practitioner
Primary
3767
MN
363LF0000X
Family Nurse Practitioner
2008007079
MN
Other
Enumeration date
12/05/2008
Last updated
09/29/2020
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