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General NPI Number Information
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NPI Number | 1891177762
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Entity Type | Individual
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Provider Name | TAMI JO HIRSCH
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Gender | Female
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 3400 W 66TH ST SUITE 290
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City | MINNEAPOLIS
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State | MN
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Zip | 55435-2111
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Country | US
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Telephone | 952-914-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 11040 PIERCE ST NE
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City | BLAINE
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State | MN
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Zip | 55434-3781
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Country | US
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Telephone | 763-381-7280
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CNP 3933
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License Number State | MN
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