Individual
MS. TANYA RAE GUNDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
106 N 4TH AVE, FERGUS FALLS, MN 56537-1034
(218) 998-3778
(218) 998-3187
Mailing address
PO BOX 86, 521 10TH ST, HAWLEY, MN 56549
(218) 790-1599
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L0563725
MN
Other
Enumeration date
04/25/2007
Last updated
07/08/2007
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