Individual
TARA DEITRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
259 1ST ST, MINEOLA, NY 11501-3957
(516) 741-0570
(516) 741-8276
Mailing address
17 KENWOOD RD, GARDEN CITY, NY 11530-3034
(516) 248-1420
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
9330
NY
Other
Enumeration date
09/25/2006
Last updated
11/29/2017
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