Provider Demographics
NPI:1376050963
Name:HAUSAUER, TASHA
Entity type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:
Last Name:HAUSAUER
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 1:921 S 9TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5851
Mailing Address - Country:US
Mailing Address - Phone:701-328-3937
Mailing Address - Fax:
Practice Address - Street 1:921 S 9TH ST STE 110
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5851
Practice Address - Country:US
Practice Address - Phone:701-328-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17Medicaid