Provider Demographics
NPI:1396155073
Name:GLEAVE, TARA LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:GLEAVE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:GLEAVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:1472 EAST 820 NORTH
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097
Mailing Address - Country:US
Mailing Address - Phone:801-226-1227
Mailing Address - Fax:801-226-1237
Practice Address - Street 1:1472 E 820 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5481
Practice Address - Country:US
Practice Address - Phone:801-226-1227
Practice Address - Fax:801-226-1237
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT357644-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse