Provider Demographics
NPI:1376224790
Name:TARVESTAD, MINDY (RRT)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:TARVESTAD
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:SVALESON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RRT
Mailing Address - Street 1:15452 15TH ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTER
Mailing Address - State:ND
Mailing Address - Zip Code:58048-9766
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2101 ELM ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-2417
Practice Address - Country:US
Practice Address - Phone:701-232-3241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR-1255227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered