Individual
TARA NICHELLE FEARS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2156 N 30TH ST, PHILADELPHIA, PA 19121-1101
(215) 397-7823
Mailing address
2156 N 30TH ST, PHILADELPHIA, PA 19121-1101
(215) 530-4050
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
284121
PA
Other
Enumeration date
02/17/2023
Last updated
10/24/2023
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