Healthcare Provider Details

I. General information

NPI: 1992158216
Provider Name (Legal Business Name): TARYN ROBBERSTAD CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARYN OTTO CNP

II. Dates (important events)

Enumeration Date: 07/21/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8000
  • Fax:
Mailing address:
  • Phone: 701-364-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR36862
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: