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General NPI Number Information
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NPI Number | 1225507890
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Entity Type | Organization
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Legal Business Name | JONES, TARA
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Dates
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Enumeration Date | 11/13/2018
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 3606 MAIN ST
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City | VANCOUVER
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State | WA
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Zip | 98663-2257
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Country | US
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Telephone | 607-779-8698
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Fax |
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Provider Business Mailing Address
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Address Line | 3606 MAIN ST STE 105
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City | VANCOUVER
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State | WA
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Zip | 98663-2235
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Country | US
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Telephone | 607-779-8698
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Fax |
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | TARA JONES
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Credential |
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Telephone | 607-779-8698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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