Basic Information
| Provider Information | |||||||||
| NPI: | 1205064862 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TARKLESON | ||||||||
| FirstName: | JAYNE | ||||||||
| MiddleName: | ARLENE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TARKLESON | ||||||||
| OtherFirstName: | JAYNE | ||||||||
| OtherMiddleName: | ARLENE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 173 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035843508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038379005 | ||||||||
| FaxNumber: | 6037885029 | ||||||||
| Practice Location | |||||||||
| Address1: | 8 CLOVER LN | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | WHITEFIELD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035983343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038379005 | ||||||||
| FaxNumber: | 6037885027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2009 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 5101018340 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 15560 | NH | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.