Provider Demographics
NPI:1366257016
Name:STEPHENS, TARA E
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:NE
Mailing Address - Zip Code:68832-9648
Mailing Address - Country:US
Mailing Address - Phone:308-379-3978
Mailing Address - Fax:
Practice Address - Street 1:111 E PINE ST
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:NE
Practice Address - Zip Code:68832-9648
Practice Address - Country:US
Practice Address - Phone:308-379-3978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion