Healthcare Provider Details

I. General information

NPI: 1972334506
Provider Name (Legal Business Name): TARA MAE PLATT AAC, CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA MAE PLATT CNA

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 W GARDNER AVE
SPOKANE WA
99201-2059
US

IV. Provider business mailing address

2919 N MAYFAIR ST APT 17
SPOKANE WA
99207-2055
US

V. Phone/Fax

Practice location:
  • Phone: 509-503-6010
  • Fax: 833-597-8372
Mailing address:
  • Phone: 509-868-6576
  • Fax: 833-597-8372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: