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Individual
TARA D BOURNAY
Active
Individual
TARA D BOURNAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101020245
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900001556
PRIORITY HEALTH
MI
Enumeration date
05/14/2013
Last updated
10/13/2020
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