Provider Demographics
NPI:1518208180
Name:TOWNSEND, TARA NICOLE
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:TOWNSEND
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:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:TOLLHOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:93667-0460
Mailing Address - Country:US
Mailing Address - Phone:559-283-2318
Mailing Address - Fax:
Practice Address - Street 1:29925 BURROUGH VALLEY RD
Practice Address - Street 2:
Practice Address - City:TOLLHOUSE
Practice Address - State:CA
Practice Address - Zip Code:93667-9718
Practice Address - Country:US
Practice Address - Phone:559-283-2318
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist