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General NPI Number Information
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NPI Number | 1609853415
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Entity Type | Individual
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Provider Name | TARA L SCHLATTMAN
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Gender | Female
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 09/19/2024
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Provider Practice Location Address
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Address Line | PARK NICOLLET CLINIC SENIOR SERVICES 3850 PARK NICOLLET BLVD
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City | ST LOUIS PARK
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State | MN
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Zip | 55416
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Country | US
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Telephone | 952-993-5041
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Fax |
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Provider Business Mailing Address
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Address Line | 2925 CHICAGO AVE
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City | MINNEAPOLIS
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State | MN
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Zip | 55407-1321
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Country | US
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Telephone | 952-993-7169
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Fax | 952-993-0300
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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 | 163WG0600X
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Taxonomy Name | Gerontology Registered Nurse
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License Number | R 141410-3
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 15488-33
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License Number State | WI
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