Provider Demographics
NPI:1619302247
Name:BINDL, TARA JILL (CRNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JILL
Last Name:BINDL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:JILL
Other - Last Name:MOSSHOLDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:260 26TH ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2203
Mailing Address - Country:US
Mailing Address - Phone:608-643-7171
Mailing Address - Fax:608-643-7147
Practice Address - Street 1:1836 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-5429
Practice Address - Country:US
Practice Address - Phone:608-782-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152814367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered