Provider Demographics
NPI:1053661983
Name:LAW, TAMI L (LPN)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:L
Last Name:LAW
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 1:122 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640-2115
Mailing Address - Country:US
Mailing Address - Phone:740-286-4426
Mailing Address - Fax:
Practice Address - Street 1:122 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-2115
Practice Address - Country:US
Practice Address - Phone:740-286-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-105711164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse