Provider Demographics
NPI:1790451573
Name:HAUERSPERGER, TAYLOR R (PA-C)
Entity Type:Individual
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First Name:TAYLOR
Middle Name:R
Last Name:HAUERSPERGER
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:244 WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5687
Practice Address - Country:US
Practice Address - Phone:812-669-0141
Practice Address - Fax:888-358-7705
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-09-07
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Provider Licenses
StateLicense IDTaxonomies
IN10003334A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant