Provider Demographics
NPI:1588138770
Name:DANIELSON, TAMMY M (PA-C)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:DANIELSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5615 XERXES AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-2819
Mailing Address - Country:US
Mailing Address - Phone:763-581-5630
Mailing Address - Fax:763-581-5631
Practice Address - Street 1:5615 XERXES AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55430
Practice Address - Country:US
Practice Address - Phone:763-581-5630
Practice Address - Fax:763-581-5631
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant