Individual
TARA VANDERPOOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1425 E TETON BLVD APT 4, GREEN RIVER, WY 82935-5873
(307) 349-7565
Mailing address
1425 E TETON BLVD APT 4, GREEN RIVER, WY 82935-5873
(307) 349-7565
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/30/2016
Last updated
03/30/2016
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