Individual
TARA HEDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
698 CIRCLE DR, MULLENS, WV 25882-1347
(419) 610-8264
Mailing address
698 CIRCLE DR, MULLENS, WV 25882-1347
(419) 610-8264
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
2046163
KY
164W00000X
Licensed Practical Nurse
Primary
34801
WV
164W00000X
Licensed Practical Nurse
PN.130012-M-IV
OH
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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