Provider Demographics
NPI:1114462421
Name:MARTIN, TAMERA RUSCHELLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:RUSCHELLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMERA
Other - Middle Name:RUSCHELLE
Other - Last Name:MCNEAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16352 PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3742
Mailing Address - Country:US
Mailing Address - Phone:303-840-7175
Mailing Address - Fax:
Practice Address - Street 1:16352 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-3742
Practice Address - Country:US
Practice Address - Phone:303-840-7175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1618090163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator