Individual
TARA A POWERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5157
(703) 890-2650
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0413744148
IL
367500000X
Certified Registered Nurse Anesthetist
209010041
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
R218521
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214468900
—
MD
Enumeration date
11/15/2012
Last updated
01/08/2018
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