Healthcare Provider Details

I. General information

NPI: 1871909242
Provider Name (Legal Business Name): TIFFANY FLATEN M.S., LN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9325 UPLAND LN N STE 310
MAPLE GROVE MN
55369-4451
US

IV. Provider business mailing address

4450 31ST AVE S
FARGO ND
58104-4556
US

V. Phone/Fax

Practice location:
  • Phone: 763-300-4816
  • Fax: 763-229-1002
Mailing address:
  • Phone: 763-300-4816
  • Fax: 763-229-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: