Provider Demographics
NPI:1144511726
Name:SNELSON, TARA A (ARDMS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:A
Last Name:SNELSON
Suffix:
Gender:F
Credentials:ARDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 802
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50304-0802
Mailing Address - Country:US
Mailing Address - Phone:515-643-5670
Mailing Address - Fax:515-643-5671
Practice Address - Street 1:5900 E UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-8457
Practice Address - Country:US
Practice Address - Phone:515-643-5670
Practice Address - Fax:515-643-5671
Is Sole Proprietor?:No
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1024992471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography