Provider Demographics
NPI:1063860401
Name:TAMMY BYDLON HEALTH CONSULTANT
Entity Type:Organization
Organization Name:TAMMY BYDLON HEALTH CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYDLON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:612-483-1491
Mailing Address - Street 1:7919 NEAL AVE N
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-9379
Mailing Address - Country:US
Mailing Address - Phone:612-483-1491
Mailing Address - Fax:
Practice Address - Street 1:7919 NEAL AVE N
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-9379
Practice Address - Country:US
Practice Address - Phone:612-483-1491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-132766-9163WN1003X, 174H00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Multi-Specialty
No163WN1003XNursing Service ProvidersRegistered NurseNutrition SupportGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty