Mahoney, Tara L

Mahoney, Tara L is an individual health care provider with primary practice located at 80 1St St , Prairie Du Sac WI 53578-1550. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as her primary health care specialty. Mahoney, Tara L can be contacted via phone (608) 643-3311.

Contact Information

Primary practice address
80 1St St Prairie Du Sac WI 53578-1550
Phone: (608) 643-3311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 117626 Wisconsin

Profile Details

NPI number 1750472163
LBN Legal business name Mahoney, Tara L
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 28th, 2006
Last updated Jul 25th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1750472163 NPPES
Wisconsin MEDICAID 44357900
Wisconsin Other P00602726

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