Provider Demographics
NPI:1689908410
Name:THOMSON, TARA ALEXANDRA USTAINE (RN CLNC)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:ALEXANDRA USTAINE
Last Name:THOMSON
Suffix:
Gender:F
Credentials:RN CLNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1767 CENTRAL PARK AVE # 352
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2828
Mailing Address - Country:US
Mailing Address - Phone:716-316-5366
Mailing Address - Fax:
Practice Address - Street 1:1767 CENTRAL PARK AVE # 352
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2828
Practice Address - Country:US
Practice Address - Phone:716-316-5366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-26
Last Update Date:2009-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY541596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse