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General NPI Number Information
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NPI Number | 1871909242
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Entity Type | Individual
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Provider Name | TIFFANY FLATEN M.S., LN, CNS
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Gender | Female
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 9201 QUADAY AVE NE STE 205
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City | OTSEGO
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State | MN
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Zip | 55330-6604
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Country | US
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Telephone | 763-703-6962
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Fax | 651-222-9727
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Provider Business Mailing Address
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Address Line | 4655 LANNON AVE NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376-4613
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Country | US
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Telephone | 763-300-4816
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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