Healthcare Provider Details

I. General information

NPI: 1992164354
Provider Name (Legal Business Name): TARA A SWENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 ROBINSON DRIVE
WALLKILL NY
12589
US

IV. Provider business mailing address

90 ROBINSON DRIVE
WALLKILL NY
12589
US

V. Phone/Fax

Practice location:
  • Phone: 845-895-7156
  • Fax: 845-895-7173
Mailing address:
  • Phone: 845-895-7156
  • Fax: 845-895-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33 336453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: