Smith, Tara Shannon

Smith, Tara Shannon is an individual health care provider with primary practice located at 26005 Ridge Rd Suite 200, Damascus MD 20872-1892. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Midwife, Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife. Other Service Providers / Midwife is her primary health care specialty. Smith, Tara Shannon can be contacted via phone (301) 414-2300.

Contact Information

Primary practice address
26005 Ridge Rd Suite 200 Damascus MD 20872-1892
Phone: (301) 414-2300
Fax: (301) 414-2306
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Midwife 176B00000X 0024165986 Virginia
Nursing Service Providers / Registered Nurse 163W00000X 0001146963 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Advanced Practice Midwife 367A00000X AC00911 Maryland

Profile Details

NPI number 1285608703
LBN Legal business name Smith, Tara Shannon
Credentials Certified Nurse Midwife (CNM)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 13th, 2006
Last updated Feb 15th, 2012 - about 13 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 1285608703 NPPES
Virginia MEDICAID 010130484
Virginia MEDICAID 7002042
Virginia Other 175079
Virginia MEDICAID 010061873
Virginia Other 2125746
Virginia Other 75928N

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