Doctor Name: | MR. NATHAN TIEDEMAN |
NPI Number: | 1285083436 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DNP, FNP, RN |
License Number: | CP001093 |
Business Practice Address: | 205 Orchard Dr Sisseton, SD - 572622312 |
Business Phone Number: | 6056987647 |
Business Fax Number: | |
Mailing Address: | 205 Orchard Dr, SISSETON |
State: | SD |
Postal Code: | 572622312 |
Phone Number: | 6056987647 |
Fax Number: | |
NPI Enumeration Date: | 06/08/2016 |
NPI Last Update Date: | 06/13/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CP001093 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SD |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |