1134331663 NPI number — MRS. TANYA NICHOLE STUHAUG M.S., LSW

Table of content: MRS. TANYA NICHOLE STUHAUG M.S., LSW (NPI 1134331663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134331663 NPI number — MRS. TANYA NICHOLE STUHAUG M.S., LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STUHAUG
Provider First Name:
TANYA
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134331663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4006 2ND ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOORHEAD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56560-5645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-287-1695
Provider Business Mailing Address Fax Number:
701-280-9520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1112 NODAK DR S
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-280-9545
Provider Business Practice Location Address Fax Number:
701-280-9520
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  4061 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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