Provider Demographics
NPI:1649768706
Name:ALVAREZ, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ALVAREZ
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 1:553 TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:NICKELSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24271-3507
Mailing Address - Country:US
Mailing Address - Phone:276-345-5367
Mailing Address - Fax:
Practice Address - Street 1:553 TAYLOR ST
Practice Address - Street 2:
Practice Address - City:NICKELSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24271-3507
Practice Address - Country:US
Practice Address - Phone:276-345-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty