Healthcare Provider Details

I. General information

NPI: 1821895251
Provider Name (Legal Business Name): TANNER R HILL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 MORRIS RD
BLOOMINGTON MN
55437-2839
US

IV. Provider business mailing address

10450 MORRIS RD
BLOOMINGTON MN
55437-2839
US

V. Phone/Fax

Practice location:
  • Phone: 952-240-8506
  • Fax:
Mailing address:
  • Phone: 952-240-8506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: