Healthcare Provider Details

I. General information

NPI: 1730462631
Provider Name (Legal Business Name): TAMMY CAROL BRANDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY CAROL JOHANNING

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S
FARGO ND
58103-5800
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-8640
  • Fax:
Mailing address:
  • Phone: 701-234-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberR31682
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number134416-3
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7477
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: