Provider Demographics
NPI:1467115410
Name:TARAU, BOGDAN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BOGDAN
Middle Name:
Last Name:TARAU
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N RANDALL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-2303
Mailing Address - Country:US
Mailing Address - Phone:847-429-3988
Mailing Address - Fax:847-324-2195
Practice Address - Street 1:1435 N RANDALL RD STE 206
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-2303
Practice Address - Country:US
Practice Address - Phone:847-429-3988
Practice Address - Fax:847-324-2195
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily