Provider Demographics
NPI:1598154593
Name:TRUAX-NEWHOUSE, TARA (R135416-6)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:TRUAX-NEWHOUSE
Suffix:
Gender:F
Credentials:R135416-6
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15140 DUPONT PATH
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-5850
Mailing Address - Country:US
Mailing Address - Phone:651-308-2528
Mailing Address - Fax:952-777-2256
Practice Address - Street 1:2808 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2148
Practice Address - Country:US
Practice Address - Phone:952-808-3219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN163W00000X163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice