Provider Demographics
NPI:1477651628
Name:HARDER, TAMMIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:J
Last Name:HARDER
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 1:2401 DEMERS AVE -ALTRU BUSINESS CENTER
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-1891
Mailing Address - Fax:701-776-5448
Practice Address - Street 1:1380 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4059
Practice Address - Country:US
Practice Address - Phone:701-795-2000
Practice Address - Fax:701-780-4391
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0031363A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND71216Medicaid
NDN4691OtherBLUE SHIELD
ND18978OtherBCBSND
ND71216Medicaid
NDR02160Medicare UPIN