Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | OK |
NPI | 1164063970 |
---|---|
Provider Name | Mary Tarango |
First Address | Perryton, TX 79070-1123 |
Second Address | Hardesty, OK 73944 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2019 |
Last Update Date | 02/10/2019 |