Healthcare Provider Details

I. General information

NPI: 1114558830
Provider Name (Legal Business Name): TISHA KAMROWSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 06/21/2024
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 4TH AVE NW
MINOT ND
58703-2912
US

IV. Provider business mailing address

1705 4TH AVE NW
MINOT ND
58703-2912
US

V. Phone/Fax

Practice location:
  • Phone: 701-839-0474
  • Fax:
Mailing address:
  • Phone: 701-839-0474
  • Fax: 701-839-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR42161
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: