Individual
TARA L DESO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
385 GROVE ST, WORCESTER, MA 01605-3924
(508) 595-2000
(508) 853-7149
Mailing address
5 NEPONSET ST, WOT 2ND FL, STE C203, WORCESTER, MA 01606-2714
(508) 595-2000
(508) 853-7149
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
RN284675
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110158765A
—
MA
Enumeration date
07/29/2019
Last updated
02/25/2020
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