Healthcare Provider Details

I. General information

NPI: 1598154593
Provider Name (Legal Business Name): TARA TRUAX-NEWHOUSE R135416-6
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 01/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 BROOKVIEW DR
BURNSVILLE MN
55337-2148
US

IV. Provider business mailing address

15140 DUPONT PATH
APPLE VALLEY MN
55124-5850
US

V. Phone/Fax

Practice location:
  • Phone: 952-808-3219
  • Fax:
Mailing address:
  • Phone: 651-308-2528
  • Fax: 952-777-2256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number163W00000X
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: