Provider Demographics
NPI:1689493694
Name:WEISENBURGER, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:WEISENBURGER
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 1:15446 N GREENWAY HAYDEN LOOP UNIT 1032
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3095
Mailing Address - Country:US
Mailing Address - Phone:480-766-2284
Mailing Address - Fax:
Practice Address - Street 1:7025 N 57TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85301-2517
Practice Address - Country:US
Practice Address - Phone:480-766-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist