Individual
MRS. TARA ELLEN KOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
505 BROADWAY ST, BARABOO, WI 53913-2183
(608) 355-4200
(608) 524-7990
Mailing address
PO BOX 29, BARABOO, WI 53913-0029
(608) 355-4200
(608) 524-7990
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
133039-030
WI
Other
Enumeration date
12/08/2009
Last updated
12/08/2009
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