| Doctor Name: | TARA J GENGLER |
| NPI Number: | 1396078051 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 209007770 |
| Business Practice Address: | 1007 Nw 3rd St Aledo, IL - 612311317 |
| Business Phone Number: | 3095823789 |
| Business Fax Number: | |
| Mailing Address: | 865 Lincoln Rd, Suite L10 BETTENDORF |
| State: | IA |
| Postal Code: | 527224190 |
| Phone Number: | 5633559191 |
| Fax Number: | 5633553419 |
| NPI Enumeration Date: | 09/14/2009 |
| NPI Last Update Date: | 06/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209007770 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |