Provider Demographics
NPI:1962517227
Name:HILSCHER DECKER, TARA L (CRNA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:HILSCHER DECKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 UNIVERSITY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-234-1728
Mailing Address - Fax:701-234-7334
Practice Address - Street 1:3171 44TH ST S UNIT 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8521
Practice Address - Country:US
Practice Address - Phone:800-437-4387
Practice Address - Fax:701-235-0330
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 147251-4367500000X
NDR33165367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14706Medicaid
MN601823800Medicaid
ND14706Medicaid
MN601823800Medicaid
MN430005679Medicare ID - Type Unspecified