Healthcare Provider Details

I. General information

NPI: 1578555082
Provider Name (Legal Business Name): SUSAN A TAUZELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 CROSBY DR
HUDSON WI
54016-7869
US

IV. Provider business mailing address

738 CROSBY DR
HUDSON WI
54016-7869
US

V. Phone/Fax

Practice location:
  • Phone: 715-377-9863
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR 122511-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: