Individual
TARA MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4545 N 24TH ST, MILWAUKEE, WI 53209-6272
(414) 651-1357
Mailing address
PO BOX 170222, MILWAUKEE, WI 53217-8021
(414) 651-1357
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88-0792965
—
WI
Enumeration date
02/23/2022
Last updated
02/23/2022
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