Healthcare Provider Details

I. General information

NPI: 1861540080
Provider Name (Legal Business Name): TAMI LYNN VALLARANO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E 28TH ST
MINNEAPOLIS MN
55407-3723
US

IV. Provider business mailing address

20885 GEORGIA AVE N
FOREST LAKE MN
55025-8014
US

V. Phone/Fax

Practice location:
  • Phone: 612-775-3041
  • Fax:
Mailing address:
  • Phone: 651-464-5433
  • Fax: 334-460-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberR 119919-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: