Provider Demographics
NPI:1811399926
Name:FOREMAN, TARA
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:FOREMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:FOREMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:12714 CROSSBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44135-3723
Mailing Address - Country:US
Mailing Address - Phone:216-835-9074
Mailing Address - Fax:216-663-7113
Practice Address - Street 1:12714 CROSSBURN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44135-3723
Practice Address - Country:US
Practice Address - Phone:216-663-6100
Practice Address - Fax:216-663-7113
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN91043164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse