Provider Demographics
NPI:1417411380
Name:GEBUR, TARA DAWN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:DAWN
Last Name:GEBUR
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 1:3200 22ND ST S APT C42
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6570
Mailing Address - Country:US
Mailing Address - Phone:701-793-1977
Mailing Address - Fax:
Practice Address - Street 1:3200 22ND ST S APT C42
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6570
Practice Address - Country:US
Practice Address - Phone:701-793-1977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer