Provider Demographics
NPI:1902370372
Name:HOHLSTEIN, TARA BIANCA (RN)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BIANCA
Last Name:HOHLSTEIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 ELLIE RAE DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-1468
Mailing Address - Country:US
Mailing Address - Phone:608-370-4757
Mailing Address - Fax:
Practice Address - Street 1:3181 CONSERVANCY ESTATES LN
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-9249
Practice Address - Country:US
Practice Address - Phone:608-235-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI232919-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health