Healthcare Provider Details

I. General information

NPI: 1407367360
Provider Name (Legal Business Name): TINA JUNE YEARY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TINA JUNE SALMONSON NP

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 DELLWOOD ST S
CAMBRIDGE MN
55008-1920
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 763-689-8700
  • Fax:
Mailing address:
  • Phone: 651-262-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1754342
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number234882
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8178
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5531
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: