Tavia Anderson

NPI 1053709675 · on the registry since 2015 · sole proprietor

Practice

Address: 2400 W 102nd St Apt 101
Bloomington, MN 55431
Phone: (612) 203-4535
Fax: (952) 217-4427
Organisation at this address: Gentle Guardians Llc
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy: 172A00000X
172A00000X
Also registered as: 104100000X
171M00000X
251E00000X
101Y00000X
101YP2500X
Licence states on file: MN
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2021-03-17

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Minnesota