Provider Demographics
NPI:1558189043
Name:LEE, TARA LYNN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:LEE
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 1:1605 EARLY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7923
Mailing Address - Country:US
Mailing Address - Phone:740-415-0054
Mailing Address - Fax:
Practice Address - Street 1:941 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-2166
Practice Address - Country:US
Practice Address - Phone:740-415-0054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide