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General NPI Number Information
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NPI Number | 1396189171
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Entity Type | Individual
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Provider Name | JAMES WASSEL TARASUIK JR. FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 04/23/2013
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 618-669-2657
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Fax |
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Provider Business Mailing Address
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Address Line | 379 HUG CEMETERY RD
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City | POCAHONTAS
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State | IL
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Zip | 62275-3532
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Country | US
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Telephone | 618-651-0353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209010372
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License Number State | IL
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