MEDICARE: TERESA ANN TANGEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	737926	AK

General Provider Information

NPI Number	:	1851555007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA ANN TANGEN

Provider Business Mailing Address
First Line	:	PO BOX 299136
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99629-9136
Country	:	US
Telephone Number	:	907-892-6944
Fax Number	:

Provider Business Practice Location Address
First Line	:	12528 HAWK LN
Second Line	:
City	:	HOUSTON
State	:	AK
Zip	:	99694-1252
Country	:	US
Telephone Number	:	907-892-6944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2008
Last Update Date	:	07/17/2008

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Directions to “ TERESA ANN TANGEN ” Practice Location

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