Provider Demographics
NPI:1083818603
Name:BRISTER, TAMMY MARIE (QMHA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:BRISTER
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:MARIE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:QMHA
Mailing Address - Street 1:1297 RING LN NE
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-4834
Mailing Address - Country:US
Mailing Address - Phone:503-361-2702
Mailing Address - Fax:
Practice Address - Street 1:1297 RING LN NE
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-4834
Practice Address - Country:US
Practice Address - Phone:503-361-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator