Provider Demographics
NPI:1164063970
Name:TARANGO, MARY (MIDWIFE)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TARANGO
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1123
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-1123
Mailing Address - Country:US
Mailing Address - Phone:806-228-6748
Mailing Address - Fax:
Practice Address - Street 1:RR 21 APT 13
Practice Address - Street 2:
Practice Address - City:HARDESTY
Practice Address - State:OK
Practice Address - Zip Code:73944
Practice Address - Country:US
Practice Address - Phone:806-228-6748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife