Healthcare Provider Details

I. General information

NPI: 1336385525
Provider Name (Legal Business Name): TANJA K FINDLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANJA K RANDALL

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 PINE ST
HIGGINSVILLE MO
64037-1877
US

IV. Provider business mailing address

3401 PINE ST
HIGGINSVILLE MO
64037-1877
US

V. Phone/Fax

Practice location:
  • Phone: 660-584-2192
  • Fax: 660-584-3771
Mailing address:
  • Phone: 660-584-2192
  • Fax: 660-584-3771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2003016241
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number2003016241
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: