Healthcare Provider Details

I. General information

NPI: 1417786302
Provider Name (Legal Business Name): TARA LYNN MCDOUGAL RN, CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6205 S FAIRFAX CT
CENTENNIAL CO
80121-3418
US

IV. Provider business mailing address

6205 S FAIRFAX CT
CENTENNIAL CO
80121-3418
US

V. Phone/Fax

Practice location:
  • Phone: 720-252-6631
  • Fax:
Mailing address:
  • Phone: 720-252-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number0195484
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: