Healthcare Provider Details

I. General information

NPI: 1366161424
Provider Name (Legal Business Name): TANYA LIUKONEN DNP, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number104407421
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: