| NPI | 1538552864 |
|---|---|
| Former Name | TARA MARIE REBERGER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 268594) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN 71005556A) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2022-01-13 |