Provider Demographics
NPI:1831428804
Name:CORNEHL, TARA MARIE (LMP)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:MARIE
Last Name:CORNEHL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N OLYMPIC AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-7222
Mailing Address - Country:US
Mailing Address - Phone:425-737-2000
Mailing Address - Fax:
Practice Address - Street 1:3032 252ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-7222
Practice Address - Country:US
Practice Address - Phone:425-737-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60045641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist