Provider Demographics
NPI:1356641831
Name:TAGGART, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:TAGGART
Suffix:
Gender:F
Credentials:NP
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 PARK AVE
Mailing Address - Street 2:DEPT OF ORTHOPEDICS G2
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55415-1623
Mailing Address - Country:US
Mailing Address - Phone:612-873-9997
Mailing Address - Fax:612-904-4203
Practice Address - Street 1:701 PARK AVE
Practice Address - Street 2:DEPT OF ORTHOPEDICS G2
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-9997
Practice Address - Fax:612-904-4203
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19890363LA2200X
MNR215096-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health