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Individual
TARA LEE
Active
Individual
TARA LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R040117
SD
363L00000X
Nurse Practitioner
Primary
CP001333
SD
363LF0000X
Family Nurse Practitioner
CP001333
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CP001333
MEDICAL LICENSE
SD
01
—
R040117
LICENSE
SD
Enumeration date
12/16/2017
Last updated
04/18/2022
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