Provider Demographics
NPI:1831462639
Name:LOPEZ, TARAH (BS)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-2117
Mailing Address - Country:US
Mailing Address - Phone:870-847-5517
Mailing Address - Fax:
Practice Address - Street 1:120 NIX RIDGE RD
Practice Address - Street 2:
Practice Address - City:ASH FLAT
Practice Address - State:AR
Practice Address - Zip Code:72513-9017
Practice Address - Country:US
Practice Address - Phone:870-994-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist