Individual provider · Type 1 NPI

Ethan Jerome Taddy

Student in an Organized Health Care Education/Training Program · Arden Hills, MN

NPI number 1740126259 Active

Practice location

2 Pine Tree Dr
Arden Hills, MN 55112-3754

Call (651) 635-8000 Map

Mailing address

3823 Colgate Ave
Minnetonka, MN 55345-1706

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

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About NPI 1740126259

Ethan Jerome Taddy's National Provider Identifier is 1740126259, issued on Apr 27, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Arden Hills, MN. The record was last updated on Apr 27, 2026.