Provider Demographics
NPI:1194553156
Name:STAVN, TANNER MICHAEL (DNP-FNP)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:MICHAEL
Last Name:STAVN
Suffix:
Gender:M
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 REDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1463
Mailing Address - Country:US
Mailing Address - Phone:701-214-3195
Mailing Address - Fax:
Practice Address - Street 1:500 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4445
Practice Address - Country:US
Practice Address - Phone:701-222-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND200083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily