Provider Demographics
NPI:1417432683
Name:ESTREM, TAMMY J (PA-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:ESTREM
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:8139 59TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NEW HOPE
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2764
Mailing Address - Country:US
Mailing Address - Phone:651-428-0220
Mailing Address - Fax:
Practice Address - Street 1:909 FULTON ST SE FL 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:651-293-3900
Practice Address - Fax:612-365-0369
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2024-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12800363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant