Provider Demographics
NPI:1467887554
Name:WITHEY, TARA (CCD, CCBE)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:WITHEY
Suffix:
Gender:F
Credentials:CCD, CCBE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 BROOKSIDE TER W
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:181 BROOKSIDE TER W
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5932
Practice Address - Country:US
Practice Address - Phone:716-310-3926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-07
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula