Individual
TARA L MAHONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
80 1ST ST, PRAIRIE DU SAC, WI 53578-1550
(608) 643-3311
Mailing address
80 1ST ST, PRAIRIE DU SAC, WI 53578-1550
(608) 643-3311
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
117626
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44357900
—
WI
01
—
P00602726
RAILROAD MEDICARE
WI
Enumeration date
09/28/2006
Last updated
07/25/2008
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