Provider Demographics
NPI:1831815067
Name:UDY, TARA LEE (RN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:UDY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEE
Other - Last Name:MURDOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:884 W 225 S
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5533
Mailing Address - Country:US
Mailing Address - Phone:801-857-1396
Mailing Address - Fax:
Practice Address - Street 1:585 N 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1548
Practice Address - Country:US
Practice Address - Phone:801-374-1801
Practice Address - Fax:801-216-8357
Is Sole Proprietor?:No
Enumeration Date:2022-10-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10879383-4405363LF0000X
UT10879383363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology