Provider Demographics
NPI:1679381875
Name:PALO, TANYA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:PALO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:MARIE
Other - Last Name:HALVORSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:623 W FIR AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1357
Mailing Address - Country:US
Mailing Address - Phone:218-671-1043
Mailing Address - Fax:
Practice Address - Street 1:623 W FIR AVE APT 305
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1357
Practice Address - Country:US
Practice Address - Phone:701-680-7282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-20
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12413207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine