Healthcare Provider Details

I. General information

NPI: 1346919552
Provider Name (Legal Business Name): TARA L HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 S POLICY ST
SALEM NH
03079-3734
US

IV. Provider business mailing address

173 S POLICY ST
SALEM NH
03079-3734
US

V. Phone/Fax

Practice location:
  • Phone: 603-893-7053
  • Fax: 603-898-0218
Mailing address:
  • Phone: 603-893-7053
  • Fax: 603-898-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number053721-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: