Individual
TARA R WADLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1103 W LIBERTY ST, FARMINGTON, MO 63640-1921
(573) 756-6751
(573) 756-6807
Mailing address
670 MASON RIDGE CENTER DR, STE 300, SAINT LOUIS, MO 63141-8573
(573) 756-6751
(573) 756-6807
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014027283
MO
Other
Enumeration date
09/11/2014
Last updated
03/29/2021
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