Individual
TARA WHEELDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
323 E 6TH ST, PORT ANGELES, WA 98362-6203
(360) 457-8355
Mailing address
PO BOX 249, PORT ANGELES, WA 98362-0038
(360) 457-8355
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
SA60961352
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA60961352
—
WA
Enumeration date
01/13/2020
Last updated
01/13/2020
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