Healthcare Provider Details

I. General information

NPI: 1740481621
Provider Name (Legal Business Name): TARA MARY GUNTHNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY HEALTH SERVICES WASHINGTON RD
PRINCETON NJ
08544-0001
US

IV. Provider business mailing address

20 PRINCE RD
EAST BRUNSWICK NJ
08816-4516
US

V. Phone/Fax

Practice location:
  • Phone: 609-258-3139
  • Fax: 609-258-0842
Mailing address:
  • Phone: 732-238-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number26NO07327600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: