Healthcare Provider Details

I. General information

NPI: 1972410397
Provider Name (Legal Business Name): TANYA BLUE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 18TH ST SW STE 27
HURON SD
57350-3488
US

IV. Provider business mailing address

1000 18TH ST SW STE 27
HURON SD
57350-3488
US

V. Phone/Fax

Practice location:
  • Phone: 605-554-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberR038235
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: