Provider Demographics
NPI:1942227939
Name:BAUDUIN, TAMRA SUE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:SUE
Last Name:BAUDUIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2401 DEMERS AVE
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:701-780-1942
Practice Address - Street 1:1300 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201
Practice Address - Country:US
Practice Address - Phone:701-780-2300
Practice Address - Fax:701-780-1942
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NDPAC0111363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R02397Medicare UPIN