Provider Demographics
NPI:1902440951
Name:VARA, TANA ANN (HCA,NAR)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:ANN
Last Name:VARA
Suffix:
Gender:F
Credentials:HCA,NAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E PARK RD
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9125
Mailing Address - Country:US
Mailing Address - Phone:360-660-0567
Mailing Address - Fax:
Practice Address - Street 1:101 E PARK RD
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-9125
Practice Address - Country:US
Practice Address - Phone:360-660-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANA60794599376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide