Provider Demographics
NPI:1598576712
Name:POLAND, TARA (RD IBCLC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:POLAND
Suffix:
Gender:F
Credentials:RD IBCLC
Other - Prefix:
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Mailing Address - Street 1:17311 SUNSET BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-7146
Mailing Address - Country:US
Mailing Address - Phone:281-435-2110
Mailing Address - Fax:
Practice Address - Street 1:27905 COMMERCIAL PARK RD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6568
Practice Address - Country:US
Practice Address - Phone:832-245-6225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-313762174N00000X
994881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT80652OtherTEXAS DEPARTMENT OF LICENSING AND REGISTRATION
AK233652OtherDIETITIANS AND NUTRITIONISTS
994881OtherCOMMISSION OF DIETETIC REGISTRATION
L-313762OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS