Provider Demographics
NPI:1033314406
Name:TAUSEVICH, DAVID MICHAEL (CRNA, APRN, MS, CCRN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MICHAEL
Last Name:TAUSEVICH
Suffix:
Gender:M
Credentials:CRNA, APRN, MS, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MILFORD ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3651
Mailing Address - Country:US
Mailing Address - Phone:617-833-3612
Mailing Address - Fax:
Practice Address - Street 1:10 MILFORD STREET
Practice Address - Street 2:SUITE 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-833-3612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA199934367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered