Provider Demographics
NPI:1104330901
Name:SULSER, TARA (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SULSER
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 1:508 THORNTON CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-5078
Mailing Address - Country:US
Mailing Address - Phone:801-604-3124
Mailing Address - Fax:
Practice Address - Street 1:508 THORNTON CT
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-5078
Practice Address - Country:US
Practice Address - Phone:801-604-3124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9156458-3102163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health