Individual
TEGAN NICOLE JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
(218) 828-3103
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
66083
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/09/2017
Last updated
07/14/2020
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