Basic Information
| Provider Information | |||||||||
| NPI: | 1922671205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLINDEN | ||||||||
| FirstName: | TESSA | ||||||||
| MiddleName: | MALINE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 PETERSON PKWY | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562737823 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 PETERSON PKWY | ||||||||
| Address2: | |||||||||
| City: | NEW LONDON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562737823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3203542222 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2021 | ||||||||
| LastUpdateDate: | 09/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 13784 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.