Individual
MS. TARA R. CHRISTENSEN-TOURTILLOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1575 N RIVERCENTER DR, SUITE 160, MILWAUKEE, WI 53212-3978
(414) 274-7220
(414) 274-7227
Mailing address
3003 W GOOD HOPE RD, MILWAUKEE, WI 53209-2042
(414) 352-3100
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1152-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42982700
—
WI
01
—
P00682030
RR MEDICARE
WI
Enumeration date
12/29/2005
Last updated
11/30/2021
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