Provider Demographics
NPI:1023892650
Name:CZAPLA, TARA (IBCLC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CZAPLA
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N CIMMARON ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6047
Mailing Address - Country:US
Mailing Address - Phone:208-518-8581
Mailing Address - Fax:
Practice Address - Street 1:1621 W CARROLL AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-2501
Practice Address - Country:US
Practice Address - Phone:208-777-6455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDL-148668174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
L-148668OtherIBLCE