Healthcare Provider Details

I. General information

NPI: 1215942057
Provider Name (Legal Business Name): JODY SALTERN TANNER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 LOVETT AVE
BISMARCK ND
58504
US

IV. Provider business mailing address

1925 LOVETT AVE
BISMARCK ND
58504
US

V. Phone/Fax

Practice location:
  • Phone: 701-204-7706
  • Fax: 701-712-8555
Mailing address:
  • Phone: 701-204-7706
  • Fax: 701-712-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0677
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: