Provider Demographics
NPI:1487845343
Name:MACALUSO, TARRA MARIE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TARRA
Middle Name:MARIE
Last Name:MACALUSO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 WIND WILLOW WAY
Mailing Address - Street 2:APARTMENT 16
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-6101
Mailing Address - Country:US
Mailing Address - Phone:585-880-7818
Mailing Address - Fax:
Practice Address - Street 1:2100 WIND WILLOW WAY
Practice Address - Street 2:APARTMENT 16
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-6101
Practice Address - Country:US
Practice Address - Phone:585-880-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270268-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse