Provider Demographics
NPI:1093302143
Name:WARE, TAMMY JEAN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:WARE
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 1:37 ELIZABETH DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-7057
Mailing Address - Country:US
Mailing Address - Phone:304-269-5220
Mailing Address - Fax:304-269-5275
Practice Address - Street 1:37 ELIZABETH DR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-7057
Practice Address - Country:US
Practice Address - Phone:304-269-5220
Practice Address - Fax:304-269-5275
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant