| NPI | 1316609290 |
|---|---|
| Former Name | BETHANY KAREN TANGEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MN 13864) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MN 13864) |
| Enumeration Date | 2021-10-08 |
| Last Update Date | 2022-11-30 |