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General NPI Number Information
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NPI Number | 1356155683
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Entity Type | Individual
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Provider Name | TANYA SAMANTHA CROWE POWELL FNP
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Gender | Female
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Dates
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Enumeration Date | 02/06/2025
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 3000 32ND AVE S
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City | FARGO
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State | ND
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Zip | 58103-6132
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Country | US
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Telephone | 701-364-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4110 51ST AVE S
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City | FARGO
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State | ND
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Zip | 58104-7776
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Country | US
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Telephone | 701-390-6393
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Fax |
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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 | 201498
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License Number State | ND
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