Provider Demographics
NPI:1770374100
Name:SHEW, TARA RAE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RAE
Last Name:SHEW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 AVENUE B
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-2655
Mailing Address - Country:US
Mailing Address - Phone:712-435-0902
Mailing Address - Fax:
Practice Address - Street 1:1411 AVENUE B
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-2655
Practice Address - Country:US
Practice Address - Phone:712-435-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide