=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679159982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TARA B FERTILITY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2021
-----------------------------------------------------
Last Update Date | 01/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 2ND AVE SE
-----------------------------------------------------
City | ASHLEY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58413-7318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-471-9745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 N 14TH ST STE 3A
-----------------------------------------------------
City | BISMARCK
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58503-0697
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-471-9745
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TARA M HARDING
-----------------------------------------------------
Credential | DNP, FNP-C
-----------------------------------------------------
Telephone | 701-471-9745
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------