Healthcare Provider Details

I. General information

NPI: 1760269997
Provider Name (Legal Business Name): TARA LYNN FREEBORN PAULI DNP, RN, APRN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

4321 61ST ST
SACRAMENTO CA
95820-4227
US

V. Phone/Fax

Practice location:
  • Phone: 530-285-3202
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number236400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: