Provider Demographics
NPI:1528784386
Name:BRAME, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BRAME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 WILLOW CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27537-4313
Mailing Address - Country:US
Mailing Address - Phone:252-762-8787
Mailing Address - Fax:
Practice Address - Street 1:2084 ROSS MILL RD.
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27537
Practice Address - Country:US
Practice Address - Phone:252-762-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health