Provider Demographics
NPI:1669106308
Name:DINKEL, TARA LYN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYN
Last Name:DINKEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYN
Other - Last Name:EMORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1016 KITTSON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:ND
Mailing Address - Zip Code:58237-2230
Mailing Address - Country:US
Mailing Address - Phone:701-620-1229
Mailing Address - Fax:
Practice Address - Street 1:1016 KITTSON AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:ND
Practice Address - Zip Code:58237-2230
Practice Address - Country:US
Practice Address - Phone:701-620-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL17056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse