=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477702645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAWNIA ANN NETLAND APRN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/12/2008
-----------------------------------------------------
Last Update Date | 01/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 410 4TH ST SW
-----------------------------------------------------
City | MAHNOMEN
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56557-4732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-935-2514
-----------------------------------------------------
Fax | 218-935-2720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5074
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57117-5074
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-328-6585
-----------------------------------------------------
Fax | 605-312-9802
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 6263
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------