Healthcare Provider Details

I. General information

NPI: 1578962130
Provider Name (Legal Business Name): TARA HARDING FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 01/08/2024
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 CENTER AVE N
ASHLEY ND
58413-7013
US

IV. Provider business mailing address

3000 N 14TH ST STE 3A
BISMARCK ND
58503-0697
US

V. Phone/Fax

Practice location:
  • Phone: 701-288-3448
  • Fax: 701-288-3213
Mailing address:
  • Phone: 701-288-3448
  • Fax: 701-288-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR34495
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: