Provider Demographics
NPI:1275794596
Name:HOUSER, JEREMY JAMES (MPAS PA-C)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:JAMES
Last Name:HOUSER
Suffix:
Gender:M
Credentials:MPAS PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 W GOOD SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MN
Mailing Address - Zip Code:56762-1412
Mailing Address - Country:US
Mailing Address - Phone:218-745-4211
Mailing Address - Fax:182-745-3254
Practice Address - Street 1:300 W GOOD SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MN
Practice Address - Zip Code:56762-1412
Practice Address - Country:US
Practice Address - Phone:218-745-4211
Practice Address - Fax:218-745-3254
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant