Provider Demographics
NPI:1295598282
Name:KIDD-TATGE, ASHLEY MAE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MAE
Last Name:KIDD-TATGE
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 1:3913 UNITY AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2039
Mailing Address - Country:US
Mailing Address - Phone:161-299-1454
Mailing Address - Fax:
Practice Address - Street 1:1121 JACKSON ST NE STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3051
Practice Address - Country:US
Practice Address - Phone:612-353-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula