Provider Demographics
NPI:1831965920
Name:TIAM, CARINE
Entity type:Individual
Prefix:
First Name:CARINE
Middle Name:
Last Name:TIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FRANCOISE
Other - Middle Name:CARINE
Other - Last Name:KEMDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:755 CROSSROADS CAMPUS DR NE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-5074
Mailing Address - Country:US
Mailing Address - Phone:763-684-6300
Mailing Address - Fax:763-684-6305
Practice Address - Street 1:755 CROSSROADS CAMPUS DR NE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-5074
Practice Address - Country:US
Practice Address - Phone:763-684-6300
Practice Address - Fax:763-684-6305
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10997363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner