Provider Demographics
NPI:1699387597
Name:O'BRIEN, TARA (ND)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRICKHILL AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-1999
Mailing Address - Country:US
Mailing Address - Phone:603-489-3284
Mailing Address - Fax:844-325-0479
Practice Address - Street 1:100 BRICKHILL AVE STE 304
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-1999
Practice Address - Country:US
Practice Address - Phone:207-358-9591
Practice Address - Fax:844-325-0479
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENP797175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath