Doctor Name: | TARA JEAN RICK |
NPI Number: | 1003843756 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | |
Business Practice Address: | University Of Minnesota Physicians 420 Delaware St Se, Mmc276 Minneapolis, MN - 55455 |
Business Phone Number: | 6126240909 |
Business Fax Number: | |
Mailing Address: | University Of Minnesota Physicians, 420 Delaware St Se, Mmc276 MINNEAPOLIS |
State: | MN |
Postal Code: | 55455 |
Phone Number: | 6126240909 |
Fax Number: | |
NPI Enumeration Date: | 06/27/2006 |
NPI Last Update Date: | 03/23/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |