Provider Demographics
NPI:1316251291
Name:LEVY, TARA DEON PLUME (APRN, ACNS-BC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DEON PLUME
Last Name:LEVY
Suffix:
Gender:F
Credentials:APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:512-584-8404
Mailing Address - Fax:
Practice Address - Street 1:595 SW BLUFF DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702
Practice Address - Country:US
Practice Address - Phone:971-533-8732
Practice Address - Fax:541-728-2063
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114123364SA2200X
OR202000107CNS-PP364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB110645Medicare PIN