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General NPI Number Information
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NPI Number | 1033788997
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Entity Type | Individual
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Provider Name | TARA CHARBONEAU DNP APRN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/23/2021
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 2101 ELM ST N
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City | FARGO
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State | ND
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Zip | 58102-2417
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Country | US
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Telephone | 701-239-3700
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Fax | 701-451-7891
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Provider Business Mailing Address
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Address Line | 320 E MAIN ST
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City | CROSBY
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State | MN
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Zip | 56441-1645
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Country | US
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Telephone | 218-545-4497
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Fax | 218-546-4341
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 8249
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License Number State | MN
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