Provider Demographics
NPI:1114541109
Name:DURYEA, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DURYEA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 SILVER HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-1022
Mailing Address - Country:US
Mailing Address - Phone:307-751-1059
Mailing Address - Fax:
Practice Address - Street 1:5425 SILVER HILLS CIR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1022
Practice Address - Country:US
Practice Address - Phone:307-751-1059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide