DR. TARA VONNE BRODERSEN (NPI# 1336138882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336138882 |
| Entity Type | Individual |
| Full Name | DR. TARA VONNE BRODERSEN |
| Credential | DDS |
| Practice Address |
200 University Ave E Saint Paul MN 55101-2507 |
| Practice Telephone | 6512912848 |
| Practice Fax Number | 6516026885 |
| Mailing Telephone | 6512912848 |
| Mailing Fax Number | 6516026885 |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2019-03-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D11913 | MN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | MEDICARE UPIN | H400538336 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5320 Hyland Greens Dr Ste 200, Bloomington, MN 554373935 | 9528316126 |
| Street Address |
200 UNIVERSITY AVE E |
| City | SAINT PAUL |
| State | MN |
| Zip Code | 55101-2507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184236739 | Anna Rauch | Nurse Practitioner | 200 University Ave E, Saint Paul, MN 55101-2507 | 2020-08-17 |
| 1891319943 | Gillette Children's Specialty Healthcare | Non-Pharmacy Dispensing Site | 200 University Ave E, Saint Paul, MN 55101-2507 | 2020-06-04 |
| 1144843343 | Smitha Elizabeth Mathew | Orthopaedic Surgery | 200 University Ave E, Saint Paul, MN 55101-2507 | 2020-05-21 |
| 1750927554 | Carol Skerbitz | Dietitian, Registered | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-11-27 |
| 1780220798 | Karri Larson | Dietitian, Registered | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-11-25 |
| 1316583560 | Julia Lang | Dietitian, Registered | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-11-22 |
| 1033755285 | Stephanie K Campbell | Dietitian, Registered | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-11-22 |
| 1629614912 | Ashley Ann Clintsman | Dietitian, Registered | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-11-21 |
| 1770057135 | Katherine Marie Nelson | Nurse Practitioner | 200 University Ave E, Saint Paul, MN 55101-2507 | 2019-01-17 |
| 1982187464 | Natalie Bentzlin | Registered Nurse | 200 University Ave E, Saint Paul, MN 55101-2507 | 2018-09-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508480427 | El Solutions LLC | Clinic/Center | 445 Minnesota St., Ste. 1500 12, St. Paul, MN 55101 | 2020-06-05 |
| 1689211443 | Siripa Min | Nurse Anesthetist, Certified Registered | 640 Jackson Street Mail Stop 11503, St. Paul, MN 55101 | 2019-11-28 |
| 1922590488 | Diane Mcleod | Physician Assistant | Healthpartners Regions Specialty Clinics, 640 Jackson St - Mail Stop 11109e, Saint Paul, MN 55101 | 2018-05-31 |
| 1699284919 | Eric Mcgillis | Emergency Medicine | Regions Hospital - Emergency Medicine, 11102f, 640 Jackson St, St Paul, MN 55101 | 2017-09-29 |
| 1073051751 | Hannah Elizabeth Rosenthal Danielson | Physician Assistant | 640 Jackson St # Ms 11102m, Saint Paul, MN 55101 | 2017-02-02 |
| 1992182323 | Theresa Annette Cashdollar-powell | Social Worker | 640 Jackson, St Paul, MN 55101 | 2015-05-06 |
| 1770986101 | Margaret Augusta Cutter | Physician Assistant | 200 Univeristy Ave E, Saint Paul, MN 55101 | 2014-09-30 |
| 1851641419 | Lisa Rae Caturia | Occupational Therapy Assistant | 640 Jackson St, 8th Floor, St Paul, MN 55101 | 2012-09-11 |
| 1558619478 | Rph On The Go | Community/Behavioral Health | 172 E 6th Street, 704, Saint Paul, MN 55101 | 2012-08-27 |
| 1184994212 | Duyen Truong | Pharmacist | 604 Jackson Street, St. Paul, MN 55101 | 2012-01-05 |
| Find all providers in zip 55101 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831614387 | David Ji Hyun Park | Dentist | 393 Dunlap St N Ste 308, Saint Paul, MN 55104-4223 | 2017-08-06 |
| 1205289428 | Chukwujindu Onyemordi Nwaigbo | Dentist | 476 Herschel St, Apt 1, Saint Paul, MN 55104-3608 | 2016-07-22 |
| 1427302983 | Ali Barbarawi | Dentist | 1200 Robert St S, Saint Paul, MN 55118-2308 | 2012-11-06 |
| 1801029293 | Family First Dental Associates of West Point, P.C. | Dentist | 809 6th St, Saint Paul, NE 68873-1604 | 2009-09-01 |
| 1942470539 | Michael A. Kurkowski, Pa | Dentist | 3500 Rice St, Saint Paul, MN 55126-3043 | 2008-03-10 |
| 1841317732 | Mark I. Malterud, D.d.s., P.a. | Dentist | 770 Mount Curve Blvd, Saint Paul, MN 55116-1165 | 2007-03-23 |
| 1124172754 | Thomas Elliot Vukodinovich | Dentist | 542 Snelling Ave S, Saint Paul, MN 55116-1565 | 2007-01-22 |
| 1699825612 | Lezlie Ann Nelson | Dentist | 375 Jackson St Ste 200, Saint Paul, MN 55101-1806 | 2007-01-11 |
| 1174671358 | Lynn Robert Ostlund | Dentist | 1043 Payne Ave, Saint Paul, MN 55101-3840 | 2007-01-06 |
| 1295890895 | Cherokee Dental, P.a. | Dentist | 374 Annapolis St W, Saint Paul, MN 55118-1107 | 2006-12-25 |
| Find all providers in SAINT PAUL | ||||
| City | SAINT PAUL |
| Zip Code | 55101 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.