MEDICARE: MRS. TARA FOREMAN

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	164W00000X	Licensed Practical Nurse	PN91043	OH

General Provider Information

NPI Number	:	1811399926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA FOREMAN

Provider Business Mailing Address
First Line	:	12714 CROSSBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3723
Country	:	US
Telephone Number	:	216-835-9074
Fax Number	:	216-663-7113

Provider Business Practice Location Address
First Line	:	12714 CROSSBURN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44135-3723
Country	:	US
Telephone Number	:	216-663-6100
Fax Number	:	216-663-7113

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

Provider Enumeration Date	:	09/19/2014
Last Update Date	:	09/19/2014

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Directions to “ MRS. TARA FOREMAN ” Practice Location

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