Provider Demographics
NPI:1790386902
Name:LETZRING, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:LETZRING
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 1:14 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1019
Mailing Address - Country:US
Mailing Address - Phone:518-695-3255
Mailing Address - Fax:518-695-8204
Practice Address - Street 1:14 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1019
Practice Address - Country:US
Practice Address - Phone:518-695-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY751670163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool