1710223375 NPI number — MISS TARA DUNBAR BSN, RN, CMSRN

Table of content: MISS TARA DUNBAR BSN, RN, CMSRN (NPI 1710223375)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710223375 NPI number — MISS TARA DUNBAR BSN, RN, CMSRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNBAR
Provider First Name:
TARA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BSN, RN, CMSRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710223375
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TAYLOR MARION ST
Provider Second Line Business Mailing Address:
OUTPATIENT SPECIALTY CENTER - WOC NURSING
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29220-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-296-8906
Provider Business Mailing Address Fax Number:
803-296-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TAYLOR MARION ST
Provider Second Line Business Practice Location Address:
OUTPATIENT SPECIALTY CENTER - WOC NURSING
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29220-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-8906
Provider Business Practice Location Address Fax Number:
803-296-8908
Provider Enumeration Date:
12/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WX1500X , with the licence number:  71289 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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