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Individual
TARA L PUCKETT
Active
Individual
TARA L PUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
154092
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3018406
PERSONAL CARE AIDE
OH
Enumeration date
09/20/2013
Last updated
09/20/2013
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