Provider Demographics
NPI:1710223375
Name:DUNBAR, TARA (BSN, RN, CMSRN)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:DUNBAR
Suffix:
Gender:F
Credentials:BSN, RN, CMSRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TAYLOR MARION ST
Mailing Address - Street 2:OUTPATIENT SPECIALTY CENTER - WOC NURSING
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29220-0001
Mailing Address - Country:US
Mailing Address - Phone:803-296-8906
Mailing Address - Fax:803-296-8908
Practice Address - Street 1:TAYLOR MARION ST
Practice Address - Street 2:OUTPATIENT SPECIALTY CENTER - WOC NURSING
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29220-0001
Practice Address - Country:US
Practice Address - Phone:803-296-8906
Practice Address - Fax:803-296-8908
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC71289163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX1500XNursing Service ProvidersRegistered NurseOstomy Care