Provider Demographics
NPI:1700597101
Name:HAUSE, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:HAUSE
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 1:10880 BARKER CYPRESS RD APT 9102
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-3072
Mailing Address - Country:US
Mailing Address - Phone:832-784-5389
Mailing Address - Fax:
Practice Address - Street 1:10880 BARKER CYPRESS RD APT 9102
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-3072
Practice Address - Country:US
Practice Address - Phone:832-784-5389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-07
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX255005Medicaid