Provider Demographics
NPI:1427389816
Name:HOUSER-HANSON, TAMALA R (APRN)
Entity Type:Individual
Prefix:
First Name:TAMALA
Middle Name:R
Last Name:HOUSER-HANSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2797
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-2797
Mailing Address - Country:US
Mailing Address - Phone:402-354-4230
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:515 N 162ND AVE STE 301
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2540
Practice Address - Country:US
Practice Address - Phone:402-354-7320
Practice Address - Fax:402-354-7325
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111080363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025777600Medicaid
NE10026485702Medicaid
NE111080OtherNE APRN LICENSE
IA1427389816Medicaid
IA1427389816Medicaid
IA058970074Medicare PIN
NE099099342Medicare PIN