Provider Demographics
NPI:1376097907
Name:DUNSMORE, TARA (LPN CERTIFIED AREOLA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:DUNSMORE
Suffix:
Gender:F
Credentials:LPN CERTIFIED AREOLA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2556 SUMTER DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8638
Mailing Address - Country:US
Mailing Address - Phone:919-592-5580
Mailing Address - Fax:
Practice Address - Street 1:2304 WESVILL CT STE 310
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-2973
Practice Address - Country:US
Practice Address - Phone:919-592-5580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC059906164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse