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General NPI Number Information
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NPI Number | 1295080851
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Entity Type | Individual
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Provider Name | TARA SUE VANGUNDY CFNP
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Gender | Female
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Dates
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Enumeration Date | 07/19/2012
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1110 OAKWOOD AVE
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City | OAKWOOD
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State | OH
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Zip | 45419-2911
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Country | US
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Telephone | 937-885-7163
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Fax | 937-567-0670
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Provider Business Mailing Address
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Address Line | 7073 CLYO RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-4816
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Country | US
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Telephone | 937-435-5857
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Fax | 937-912-4960
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA13396
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License Number State | OH
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