Provider Demographics
NPI:1578955324
Name:GAUSE, TANIEKA (PHLEBOTOMIST)
Entity Type:Individual
Prefix:
First Name:TANIEKA
Middle Name:
Last Name:GAUSE
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 HIGHWAY 90 E STE 7
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7214
Mailing Address - Country:US
Mailing Address - Phone:843-497-4319
Mailing Address - Fax:843-249-4777
Practice Address - Street 1:287 HIGHWAY 90 E STE 7
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7214
Practice Address - Country:US
Practice Address - Phone:843-497-4319
Practice Address - Fax:843-249-4777
Is Sole Proprietor?:No
Enumeration Date:2015-03-02
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC47-3209201172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker