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General NPI Number Information
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NPI Number | 1912988809
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Entity Type | Individual
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Provider Name | DIANE TARR N.P.
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Gender | Female
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1505 COMMONWEALTH AVE
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City | BRIGHTON
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State | MA
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Zip | 02135-3605
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Country | US
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Telephone | 617-783-1441
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Fax | 617-783-1448
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Provider Business Mailing Address
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Address Line | 300 ROSEWOOD DR STE. 104
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City | DANVERS
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State | MA
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Zip | 01923-1389
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Country | US
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Telephone | 978-774-7243
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Fax | 978-774-7421
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 123730
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License Number State | MA
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