Provider Demographics
NPI:1740498104
Name:HARLOW, TANYA L
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:HARLOW
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 1:700 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1802
Mailing Address - Country:US
Mailing Address - Phone:701-234-4036
Mailing Address - Fax:701-234-4160
Practice Address - Street 1:700 1ST AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1802
Practice Address - Country:US
Practice Address - Phone:701-234-4036
Practice Address - Fax:701-234-4160
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA370882084N0400X
ND108642084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1740498104OtherHEALTHPARTNERS
ND1740498104OtherMEDICA
ND14742Medicaid
IA54281OtherWELLMARK BCBS
ND1740498104OtherMEDICA
IA54281OtherWELLMARK BCBS