Healthcare Provider Details

I. General information

NPI: 1497550305
Provider Name (Legal Business Name): TAMMY CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 3RD AVE SW
MINOT ND
58701-4346
US

IV. Provider business mailing address

4909 SHELBURNE ST
BISMARCK ND
58503-5605
US

V. Phone/Fax

Practice location:
  • Phone: 701-223-2417
  • Fax:
Mailing address:
  • Phone: 701-223-2417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: