Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2019000559 | MO |
NPI | 1003389941 |
---|---|
Provider Name | Tara N Loveland |
First Address | Sparta, MO 65753-8104 |
Second Address | Sparta, MO 65753-8104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 22/01/2019 |