Provider Demographics
NPI:1255566279
Name:RUKSTALIS, TARA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:MARIE
Last Name:RUKSTALIS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:110 FRANCIS ST STE 3B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5501
Mailing Address - Country:US
Mailing Address - Phone:617-632-7246
Mailing Address - Fax:617-632-7599
Practice Address - Street 1:110 FRANCIS ST STE 3B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5501
Practice Address - Country:US
Practice Address - Phone:617-632-7246
Practice Address - Fax:617-632-0949
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2021-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA826231H00000X
MARN2259257363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist