Provider Demographics
NPI:1386886620
Name:WILSON, TARA M (CFA)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13430 N MERIDIAN ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1405
Mailing Address - Country:US
Mailing Address - Phone:317-582-8810
Mailing Address - Fax:317-582-8863
Practice Address - Street 1:13430 N MERIDIAN ST
Practice Address - Street 2:SUITE 275
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1405
Practice Address - Country:US
Practice Address - Phone:317-582-8810
Practice Address - Fax:317-582-8863
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN113533246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN113533OtherCFA