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General NPI Number Information
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NPI Number | 1427288836
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Entity Type | Individual
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Provider Name | AMY LYNN TANGEDAHL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 11/16/2025
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST STE 310
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City | MISSOULA
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State | MT
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Zip | 59802-4003
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Country | US
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Telephone | 406-728-6520
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Fax | 406-329-2799
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Provider Business Mailing Address
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Address Line | PO BOX 31001
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone | 406-728-6520
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Fax | 406-329-2799
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA130034
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 22661
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License Number State | MT
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