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Individual
TARA MAE WANDER
Active
Individual
TARA MAE WANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5880
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48Q92WA
BCBS
MN
01
—
6400295
MEDICA
—
01
—
HP42340
HEALTHPARTNERS
—
Enumeration date
05/12/2006
Last updated
07/08/2007
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