Provider Demographics
NPI:1689381766
Name:PIEDRA, DARA ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:DARA
Middle Name:ELIZABETH
Last Name:PIEDRA
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 1:1816 BELL TOWER LN NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-2591
Mailing Address - Country:US
Mailing Address - Phone:423-413-3234
Mailing Address - Fax:
Practice Address - Street 1:1816 BELL TOWER LN NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-2591
Practice Address - Country:US
Practice Address - Phone:423-413-3234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11963909172A00000X
TN094496586172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver