Healthcare Provider Details

I. General information

NPI: 1568832541
Provider Name (Legal Business Name): MRS. TARA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA CHRISTINE WEILER MSN, AGACNP-BC

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 601
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-673-2806
  • Fax:
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024172860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: