Provider Demographics
NPI:1225511520
Name:BOYER, TARA (BSN)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:BOYER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14101 LARIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-5135
Mailing Address - Country:US
Mailing Address - Phone:531-299-2321
Mailing Address - Fax:
Practice Address - Street 1:14101 LARIMORE AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-5135
Practice Address - Country:US
Practice Address - Phone:531-299-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59781163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool