Healthcare Provider Details

I. General information

NPI: 1972047298
Provider Name (Legal Business Name): MEGHAN TIFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2016
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 YANKEE DOODLE RD
EAGAN MN
55121-2092
US

IV. Provider business mailing address

1110 YANKEE DOODLE RD
EAGAN MN
55121-2092
US

V. Phone/Fax

Practice location:
  • Phone: 651-454-3970
  • Fax:
Mailing address:
  • Phone: 651-454-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 4881
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: