Deso, Tara L

Deso, Tara L is an individual health care provider with primary practice located at 385 Grove St , Worcester MA 01605-3924. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Deso, Tara L can be contacted via phone (508) 595-2000.

Contact Information

Primary practice address
385 Grove St Worcester MA 01605-3924
Phone: (508) 595-2000
Fax: (508) 853-7149
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X RN284675 Massachusetts

Profile Details

NPI number 1306490396
LBN Legal business name Deso, Tara L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 29th, 2019
Last updated Feb 25th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306490396 NPPES
Massachusetts MEDICAID 110158765A

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