Provider Demographics
NPI:1447317656
Name:FORKER, TARA DAWN (LPN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:DAWN
Last Name:FORKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5435 COOPERMILL RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8991
Mailing Address - Country:US
Mailing Address - Phone:740-221-8061
Mailing Address - Fax:
Practice Address - Street 1:5435 COOPERMILL RD
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8991
Practice Address - Country:US
Practice Address - Phone:740-221-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN103334164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse