Individual
TARA MOMPLAISIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.P.
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 550-4642
Mailing address
6201 GREENLEIGH AVE FL 2, MIDDLE RIVER, MD 21220-2004
(410) 933-4397
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R152905
MD
363LA2100X
Acute Care Nurse Practitioner
Primary
R152905
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409460300
—
MD
01
—
R152905
NURSE PRACTITIONER
MD
Enumeration date
05/11/2006
Last updated
08/15/2024
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