Provider Demographics
NPI:1417786302
Name:MCDOUGAL, TARA LYNN (RN, CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNN
Last Name:MCDOUGAL
Suffix:
Gender:F
Credentials:RN, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6205 S FAIRFAX CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80121-3418
Mailing Address - Country:US
Mailing Address - Phone:720-252-6631
Mailing Address - Fax:
Practice Address - Street 1:6205 S FAIRFAX CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80121-3418
Practice Address - Country:US
Practice Address - Phone:720-252-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0195484163WM0102X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn