Provider Demographics
NPI:1164122206
Name:KARLSON, TANYA JO
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:JO
Last Name:KARLSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:ND
Mailing Address - Zip Code:58735
Mailing Address - Country:US
Mailing Address - Phone:701-529-4829
Mailing Address - Fax:
Practice Address - Street 1:200 5TH AVE S
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:ND
Practice Address - Zip Code:58735-5873
Practice Address - Country:US
Practice Address - Phone:701-529-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant