Individual
TARA RADA NIEBERDING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 QUINCY AVE STE 12, NAPERVILLE, IL 60540
(440) 465-7322
Mailing address
1701 QUINCY AVE STE 12, NAPERVILLE, IL 60540-6687
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
—
171WH0202X
Home Modifications Contractor
—
—
171WV0202X
Vehicle Modifications Contractor
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Enumeration date
05/14/2018
Last updated
07/10/2018
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