Individual
TARA JEANINE MANSIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5319 S 500 E STE C, OGDEN, UT 84405-7218
(801) 516-0576
Mailing address
515 S CENTER ST, OREGON CITY, OR 97045-2938
(360) 600-2008
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
DEM-LD10189489
OR
Other
Enumeration date
04/30/2018
Last updated
02/18/2019
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