Provider Demographics
NPI:1922481159
Name:TARK, ALUEM (PHD, FNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:ALUEM
Middle Name:
Last Name:TARK
Suffix:
Gender:F
Credentials:PHD, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HAWKEYE CT APT 405
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52246-2863
Mailing Address - Country:US
Mailing Address - Phone:917-747-2612
Mailing Address - Fax:
Practice Address - Street 1:241 W 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2121
Practice Address - Country:US
Practice Address - Phone:917-747-2612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY625161163W00000X
IAA155614363LF0000X
NY340256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse