MEDICARE: MS. TARA BOYER BSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	59781	NE

General Provider Information

NPI Number	:	1225511520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TARA BOYER BSN

Provider Business Mailing Address
First Line	:	14101 LARIMORE AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-5135
Country	:	US
Telephone Number	:	531-299-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	14101 LARIMORE AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-5135
Country	:	US
Telephone Number	:	531-299-2321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	09/12/2018

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