Provider Demographics
NPI:1427595172
Name:NOSECK, TARA TAYLOR (RD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:TAYLOR
Last Name:NOSECK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5175 CEREUS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-6956
Mailing Address - Country:US
Mailing Address - Phone:702-960-5640
Mailing Address - Fax:
Practice Address - Street 1:5175 CEREUS CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6956
Practice Address - Country:US
Practice Address - Phone:702-960-5640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV38450-DI-0133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered