| NPI | 1417277500 |
|---|---|
| Former Name | TARA BLUE MULLEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VT 101.0076732) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 062569-23) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2015-08-10 |