Individual
CAROLYN RENEE TAVARES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2192 MECKLENBURG RD, ITHACA, NY 14850-9322
(607) 256-3617
Mailing address
2192 MECKLENBURG RD, ITHACA, NY 14850-9322
(607) 256-3617
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
363370-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01987508
—
NY
Enumeration date
05/18/2007
Last updated
07/08/2007
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