Provider Demographics
NPI:1972334506
Name:PLATT, TARA MAE (AAC, CNA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MAE
Last Name:PLATT
Suffix:
Gender:F
Credentials:AAC, CNA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MAE
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:2919 N MAYFAIR ST APT 17
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-2055
Mailing Address - Country:US
Mailing Address - Phone:509-868-6576
Mailing Address - Fax:833-597-8372
Practice Address - Street 1:1302 W GARDNER AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2059
Practice Address - Country:US
Practice Address - Phone:509-503-6010
Practice Address - Fax:833-597-8372
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide