| NPI | 1346838026 |
|---|---|
| Former Name | TARA M MANILLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MO 2020022346) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-79643-042) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2023-11-15 |