| NPI | 1245659903 |
|---|---|
| Former Name | TARA MARIE MIKSHOWSKY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 5595-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 0237) |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2026-01-27 |