Healthcare Provider Details

I. General information

NPI: 1043961329
Provider Name (Legal Business Name): TERSIA RAULERSON HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7958 GRASSLAND DR
GODLEY TX
76044-3475
US

IV. Provider business mailing address

7958 GRASSLAND DR
GODLEY TX
76044-3475
US

V. Phone/Fax

Practice location:
  • Phone: 214-697-1360
  • Fax:
Mailing address:
  • Phone: 214-697-1360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number50682
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: