Provider Demographics
NPI:1164002077
Name:HINTZ, TANIA RAE (MS ED)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:RAE
Last Name:HINTZ
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 E THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-5014
Mailing Address - Country:US
Mailing Address - Phone:701-471-6188
Mailing Address - Fax:
Practice Address - Street 1:2403 E THAYER AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-5014
Practice Address - Country:US
Practice Address - Phone:701-471-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND000049633171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator