Basic Information
| Provider Information | |||||||||
| NPI: | 1881971943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENOX | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1175 MOUNT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039820635 | ||||||||
| FaxNumber: | 5039820627 | ||||||||
| Practice Location | |||||||||
| Address1: | 1175 MOUNT HOOD AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURN | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970719060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039820635 | ||||||||
| FaxNumber: | 5039820627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2011 | ||||||||
| LastUpdateDate: | 11/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 200241443RN | OR | Y | Nursing Service Providers | Registered Nurse |
No ID Information.