Provider Demographics
NPI:1003464439
Name:PELLES, TAMI JO
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:JO
Last Name:PELLES
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 1:611 NW BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-1526
Mailing Address - Country:US
Mailing Address - Phone:541-276-5080
Mailing Address - Fax:
Practice Address - Street 1:611 NW BAILEY AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-1526
Practice Address - Country:US
Practice Address - Phone:541-276-5080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000003809OtherOREGON OFFICE OF EQUITY & INCLUSION