Individual
TARA RELATION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GN
Contact information
Practice address
574 N STAR RD, MOOERS, NY 12958-3617
(518) 534-1411
Mailing address
574 N STAR RD, MOOERS, NY 12958-3617
(518) 534-1411
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
P06458
NY
Other
Enumeration date
06/19/2017
Last updated
06/19/2017
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