Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 103116 | AK |
N | 111NN1001X | Nutrition | 103116 | AK |
NPI | 1306210612 |
---|---|
Provider Name | Dr. Tara E Workman |
First Address | Wasilla, AK 99654-7271 |
Second Address | Wasilla, AK 99654-7271 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2015 |
Last Update Date | 14/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13661745 | CAQH (01) | AK |
1636141 | (05) | AK |