Provider Demographics
NPI:1093449324
Name:BOYUM, TARRA (RN)
Entity Type:Individual
Prefix:
First Name:TARRA
Middle Name:
Last Name:BOYUM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21369 530TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST CONCORD
Mailing Address - State:MN
Mailing Address - Zip Code:55985-5039
Mailing Address - Country:US
Mailing Address - Phone:507-251-3074
Mailing Address - Fax:
Practice Address - Street 1:21369 530TH ST
Practice Address - Street 2:
Practice Address - City:WEST CONCORD
Practice Address - State:MN
Practice Address - Zip Code:55985-5039
Practice Address - Country:US
Practice Address - Phone:507-251-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR133294-2163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health