Healthcare Provider Details

I. General information

NPI: 1356155683
Provider Name (Legal Business Name): TANYA SAMANTHA CROWE POWELL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA SAMANTHA CROWE RN

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

4110 51ST AVE S
FARGO ND
58104-7776
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8000
  • Fax:
Mailing address:
  • Phone: 701-390-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201498
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: