Provider Demographics
NPI:1225465578
Name:BLANCHARD, TARA (RN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CECIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 KEEWAYDIN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2839
Mailing Address - Country:US
Mailing Address - Phone:800-995-2673
Mailing Address - Fax:
Practice Address - Street 1:2 KEEWAYDIN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2839
Practice Address - Country:US
Practice Address - Phone:800-995-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN252286163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse