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NPI Code Detail

MEDICARE: TAMMY JO WHITE

MEDICARE: TAMMY JO WHITE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1609698323
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY JO WHITE
Provider Business Mailing Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 844-977-8323
Fax Number :
Provider Business Practice Location Address
First Line : 100 WASHINGTON AVE S STE 1210
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55401-2511
Country : US
Telephone Number : 844-977-8323
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2024
Last Update Date : 10/28/2024

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