Provider Demographics
NPI:1023399961
Name:NEILL, TARI (LM, CPM, CMT)
Entity Type:Individual
Prefix:
First Name:TARI
Middle Name:
Last Name:NEILL
Suffix:
Gender:F
Credentials:LM, CPM, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 FALL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9338
Mailing Address - Country:US
Mailing Address - Phone:831-421-4180
Mailing Address - Fax:831-335-9591
Practice Address - Street 1:351 FALL CREEK DR
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9338
Practice Address - Country:US
Practice Address - Phone:831-421-4180
Practice Address - Fax:831-335-9591
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife