Provider Demographics
NPI:1003900564
Name:TRAINER, TAMARA J (RN, WHNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:TRAINER
Suffix:
Gender:F
Credentials:RN, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 FAIRFIELD ROOM 551
Mailing Address - Street 2:DHH-OFFICE OF PUBLIC HEALTH
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-676-7470
Mailing Address - Fax:
Practice Address - Street 1:1525 FAIRFIELD ROOM 551
Practice Address - Street 2:DHH-OFFICE OF PUBLIC HEALTH
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-676-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4946363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1507105Medicaid
LA4H946F600Medicare PIN
LA1507105Medicaid