Provider Demographics
NPI:1164945804
Name:MEUSE, TA-MARA ALISA (PA-C)
Entity Type:Individual
Prefix:
First Name:TA-MARA
Middle Name:ALISA
Last Name:MEUSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HOSPITAL DR STE 203
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-6643
Mailing Address - Country:US
Mailing Address - Phone:413-536-5814
Mailing Address - Fax:
Practice Address - Street 1:10 HOSPITAL DR STE 203
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6643
Practice Address - Country:US
Practice Address - Phone:413-536-5814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant