Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | PTP-PT-LIC-9377 | MT |
NPI | 1891167946 |
---|---|
Provider Name | Tara Marie Fahrner |
First Address | Dillon, MT 59725-7379 |
Second Address | Dillon, MT 59725-7379 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2015 |
Last Update Date | 30/04/2021 |