Healthcare Provider Details

I. General information

NPI: 1811429871
Provider Name (Legal Business Name): EMILY HAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE # AO-10
MINNEAPOLIS MN
55454
US

IV. Provider business mailing address

2638 LINCOLN ST NE
MINNEAPOLIS MN
55418-3044
US

V. Phone/Fax

Practice location:
  • Phone: 612-626-4598
  • Fax:
Mailing address:
  • Phone: 651-214-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number67472
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: