Provider Demographics
NPI:1851555007
Name:TANGEN, TERESA ANN
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:TANGEN
Suffix:
Gender:F
Credentials:
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 299136
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99629-9136
Mailing Address - Country:US
Mailing Address - Phone:907-892-6944
Mailing Address - Fax:
Practice Address - Street 1:12528 HAWK LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:AK
Practice Address - Zip Code:99694-1252
Practice Address - Country:US
Practice Address - Phone:907-892-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK737926171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator