Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 45340 | MN |
Y | 2080P0205X | Pediatric Endocrinologist | 45340 | MN |
NPI | 1376629972 |
---|---|
Provider Name | Tanya L. Halvorsen |
First Address | Saint Paul, MN 55102-2387 |
Second Address | Saint Paul, MN 55102-2387 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 26/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
978163300 | (05) | MN |
I08906 | (02) | MN |