Provider Demographics
NPI:1548576044
Name:DEMKOWICZ, TARA (RN--SANEA)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:DEMKOWICZ
Suffix:
Gender:F
Credentials:RN--SANEA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 HOOPES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5772
Mailing Address - Country:US
Mailing Address - Phone:208-522-5545
Mailing Address - Fax:208-528-6773
Practice Address - Street 1:1465 HOOPES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5772
Practice Address - Country:US
Practice Address - Phone:208-522-5545
Practice Address - Fax:208-528-6773
Is Sole Proprietor?:No
Enumeration Date:2010-08-23
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN-32598163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse