Healthcare Provider Details

I. General information

NPI: 1043882863
Provider Name (Legal Business Name): TARA S LIWSKI MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1846 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

IV. Provider business mailing address

1846 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

V. Phone/Fax

Practice location:
  • Phone: 520-477-1650
  • Fax: 520-829-3551
Mailing address:
  • Phone: 520-477-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: