Provider Demographics
NPI:1215345442
Name:SEIDER, TARA (APN-NP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SEIDER
Suffix:
Gender:F
Credentials:APN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 W AINSLIE ST
Mailing Address - Street 2:UNIT #3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2715
Mailing Address - Country:US
Mailing Address - Phone:773-343-6083
Mailing Address - Fax:
Practice Address - Street 1:2707 W AINSLIE ST
Practice Address - Street 2:UNIT #3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2715
Practice Address - Country:US
Practice Address - Phone:773-343-6083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-31
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011192363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics