Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 2901020871 | MI |
NPI | 1124458609 |
---|---|
Provider Name | Dr. Fatima A Tiwana |
First Address | Lake Elmo, MN 55042-8624 |
Second Address | Lake Elmo, MN 55042-8624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2013 |
Last Update Date | 10/05/2021 |