Healthcare Provider Details

I. General information

NPI: 1033916226
Provider Name (Legal Business Name): TARA LYNN VACURA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3380 NORTHERN VALLEY PLACE
ROCHESTER MN
55906-3954
US

IV. Provider business mailing address

5860 BAKER RD
MINNETONKA MN
55345-5903
US

V. Phone/Fax

Practice location:
  • Phone: 952-767-4200
  • Fax: 952-767-4211
Mailing address:
  • Phone: 952-767-4200
  • Fax: 952-767-4211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: