Provider Demographics
NPI:1669420188
Name:TAUZELL, JASON DERRICK (CRNA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:DERRICK
Last Name:TAUZELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:DERRICK
Other - Last Name:TAUZELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:738 CROSBY DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7869
Mailing Address - Country:US
Mailing Address - Phone:715-377-9863
Mailing Address - Fax:
Practice Address - Street 1:UNITED HOSPITAL
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-241-8146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1286865367500000X
MNR-128686-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered