Provider Demographics
NPI:1295478808
Name:YATES, TARA (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8143 DUTCH STREET RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:NY
Mailing Address - Zip Code:14510-9564
Mailing Address - Country:US
Mailing Address - Phone:585-506-6801
Mailing Address - Fax:
Practice Address - Street 1:4050 AVON RD
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9721
Practice Address - Country:US
Practice Address - Phone:585-243-3451
Practice Address - Fax:585-243-8087
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY590905163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool